NHS Education for Scotland : Supporting Remote and Rural Healthcare

Ronald MacVicar & Pam Nicoll

NHS Education for Scotland

August 2013

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Executive Summary


In Scotland some twenty percent of the population live in a remote or rural area spread across ninety-four percent of the land mass that is defined as remote and rural – and meeting the requirement for improved quality of service for patients brings with it particular and critical challenges in Scotland’s remote and rural areas, and is likely to require a significant shift in skill mix across the remote and rural health and social care workforce.


The history of policy construction and implementation relating to healthcare in rural Scotland is well over a century long, and is summarised in the paper, with particular reference to the current major policy drivers, including the Quality Strategy, and the 20:20 vision for Health and Social Care. These are set in the context of international policy development in this area.

Role of Education

The remote, rural and Island Boards are clear that high level education support is integral to robust workforce planning and redesign. They need assurance that affordable, accessible education will be in place before investing in new roles, new ways of delivering service and see NES having a key role in this joint workforce planning and education partnership. There is an appreciation that although each of Scotland’s six Rural General Hospitals (RGHs) has a range of different needs and ways of working, there are some common areas of need already identified that can guide more effective design and delivery of education and training. Recruitment and retention issues are the key challenges facing rural general practice and primary care. There is a need to improve access to ongoing education, rural placements, peer-support and peer-referencing activities to support recruitment to, and retention in rural practice, and to decrease professional isolation for practitioners, and to ensure that all of this is underpinned with appropriate use of new technology.

Current NES Initiatives

NES has a raft of educational initiatives in place to support the rural workforce both through the directorate structure and the cross-cutting work led by RRHEAL, which is hosted within the medical directorate. The paper provides a brief description of these initiatives and they are also listed in Annex 1 in response to the World Health Organisation’s Global Policy Recommendations.


A number of recommendations are made for consideration in the areas of :

  • Improving recruitment and retention
  • Alignment of education and training with workforce plans
  • Educational leadership to support service redesign and improvement
  • Leadership of a national Technology Enabled Learning programme for Scotland