On 25 January 2024 our RCPsych Working in rural, remote, & coastal settings: medical education and mental health opportunities webinar, took place. This webinar showcased the medical education and mental health opportunities of working in rural, remote, and coastal settings. We heard from doctors of various grades who shared their experiences, discussing the challenges and joys of working in these locations.
Everyone uh Welcome to our webinar on working in rural remote and coastal areas um I’m Bina I’m a consultant psychiatrist and psychotherapist I’m also the director of medical education for linkoln share partnership NHS Foundation trust and uh what we before we start let’s do some housekeeping if you have any questions
Please write it in the Q&A sections if you just want to chat please write it in the chat uh chat uh box and um we’ll get started so um Georgia will put up my slides okay so rural remote and Coastal mental health and medical medical education uh okay next
Slide my agenda is just to set the scene to think about the impact of uh Mental Health Care difficulties in Rural and coastal areas which is quite different and to look at the inequalities in the provision of mental health care in Rural and coastal areas and to think about
Specifically about as a local education provider providing medical education in a rural and Coastal Mental Health Trust what are the challenges we have so to look at this problem from and through the lens of medical education it’s all about the trainee so what is the experience of trainees in a
Rural trust and to perhaps begin to think about opportunities and the way forward in addressing this issue next we must acknowledge that when we are talking about the rural and coastal areas in the four nations we’re talking about a very diverse group of uh geographies diverse group of population
Uh needs and therefore one size does not fit all there’s a lot of differences next I don’t know this is a picture of scages when you see a picture of the rural and the coastal area just the coastal Countryside I don’t know what feelings come up for you what that
Evokes for you but generally it’s a sense of Joy a sense of relaxation a sense of well-being and a sense of almost going into holiday mode yeah but what the 2021 CMO report has shown us is that this is just a facade What Lies Beneath this facade is a a hidden story of
Despair next the life expectancy the healthy life expectancy the disability free life expectancy are much lower and the standardized mortality rate are higher in uh for people living in rural and coastal areas so there is a risk of living a far shorter life in poorer health and
Getting beff old before that time for certain populations in Rural and coastal areas next this is um if you look at specifically around issues of Social and economic deprivation if you look at East lincolshire for example there are longstanding difficulties with employment there is a whole uh part of the
Population who rely on tourism which can be very scanty and very patchy and seasonal so there is a real sense of Social and economic deprivation which has a direct impact on both mental and physical health smoking is 6.7% higher smoking amongst pregnant women is 20.6 in Rural and coal areas
Whereas it’s 10.4% in the rest of England alcohol related admissions in those less than 18 years is higher substance misuse in a place like H is 18.9% whereas in the rest of England it’s 88.1% next if you look at the demographics of this area there is a high proportion of
Elderly residents over the age of 65 and if you look at the migration groups the people going into these areas they tend to be people who are uh vulnerable vulnerable who are looking for cheap housing and a a transient migration group whereas if you look at people who are migrating out of this
Area they tend to be young qualified people people with um who are looking for stable suitable jobs who want to be a part of a stable Workforce next and as we’ve seen sorry the yes um and if we’ve seen that there’s a higher rate of there’s a higher uh proportion of elderly people
Living in the these uh areas and uh if you look at long-term mental health problems like dementia and depression there’s a higher rate there’s a higher prevalence of long-term mental health problems for people living in uh Rural and coastal areas and if we specifically look at cell Farm among children and
Young adults age between the uh between 10 and 24 the rates of sell Farm is higher in uh people uh in this age group for uh young children and young adults living in coastal areas next if we think about the availability of Mental Health Services in the in the
Wide um community in the wide Countryside Services tend to be disseminated and there is particular difficulty with Recruitment and Retention of staff and therefore setting up a service you need a critical mass of staff to run to both set up a service and to run and sustain that service and
That there is a difficulty with that so if you look at difficulties in Recruitment and Retention of Consultants it’s this difficulty in recruitment of retention and um uh recruitment is across all medical grades so we have 15% fewer Consultants per head population and we also have trainees 14.6% fewer postgrad trainees in 2019
The Royal College of Physicians said that their recruitment of consultants in rural areas was 133% 13 and the recruitment in uh of consultants in urban Services was was 87% I looked for similar statistics and data um in Psychiatry and I couldn’t find uh find it next slide if you think about accessibility
Of service uh the services tend to be disseminated and it’s very uh the public transport tends to be poor I trained in urban city like uh Nottingham and the public transport is excellent and the waiting time for a taxi at any point of the day or night is about 5 to
10 minutes here the public in Lincolnshire the public transport is very poor and the waiting time for a taxi during the peak cars in the morning and the evening when there school drop offs can be anything between 1 to 3 hours services are disseminated and the difficulty in Rec Recruitment and
Retention is not just with psychiatrist career psychiatrist or Psychiatry trainees but it also extends to our colleagues from other disciplines like psychology nurses and so on so the obvious solution in today’s digital Savvi world is to have online clinics to address this difficulty with transport however in Rural and coastal
Areas the digital literacy is poor and hence the intake the the use of online clinics is poor next and if you look at the acceptability of uh me having mental health problems the stigma around Mental Health Services in Rural and coastal areas tend to be higher and the mental
Literacy mental health literacy tends to be poorer we know that in England at least every week we have one farmer who commits suicide but the um willingness to uh identify and accept having mental health problems and seek help continues to be poor next if we take places like black pool
Heartley pool um Hull and so on their social uh deprivation index is high so there’s a high level of Social and economic deprivation but if you look at their Staffing perhe head population it’s also good but if we look at these five areas have been identified as the
Areas with the most amount of uh social deprivation with the lowest Staffing level per head population and that includes East Lincolnshire next if we look at the inequalities in medical education we know that the training post 10 historically have been concentrated in urban areas like uh
London and we know that when there is a concentration of training posts in urban areas the LDA monies and the resources follow the post so if you look at um there is these areas these urban areas Urban training centers are T historically are seen as the areas of training Excellence because of higher
Number of trainers more specialty training opportunities tertiary centers and so on whereas rural areas rural training centers there is a risk of being it’s it’s historically they’ve been seen as the backward Waters of medical education next if we take Lincolnshire itself there is a very clear East West divide
In the east in areas like as you can see La Mabel thops kages these areas tend to these coastal areas tend to have more of economic and social deprivation and the Recruitment and Retention of Staff has been particularly poor in the east coast when compar to the west of Lincolnshire
Like Lincoln or Grantham or sleaford yeah and um that’s the Recruitment and Retention of staff is both for trainers consultants and also trainees um who are training in poost next slide skes and mapel thop onethird of the residents have no or low qualification and at least 42% of them
Are on benefits if you look at those over 65 in these areas we have about 32% of elderly people whereas in the rest of England it is 18% yeah next next slide if you look at the experience of training doctors I wanted to do a survey looking at the experience of training
Doctors and I couldn’t find any specific service so this was a survey that was done uh with by a medical student from Lincoln medical school as a part of a bsai project and this looked at um as a part of a bsai project and this was she
Published it so she looked at the the response rate was 60% 74% of the trainees were International Medical graduates 16% UK qualified 61% of them were between the ages of 24 to 36 and 11% of trainees lived with families and 89% lived alone next slide and if you look at what they saw
As these trainees uh rotated with between rural Lincolnshire and our neighboring Urban trusts and if you look at the unfavorable factors what came out first was transport 87% of them said that they had a worse U experience with transport when compared to previous placements next and the mean transport time was 1
Hour what we have tried to do is we’ve tried to address this by making all our work sites uh single site uh jobs we’ve changed our job description so um during their workast traines don’t have to uh travel between multiple sites most jobs are single site jobs except six jobs
Which we couldn’t because of practical reasons and of course during on calls they can use taxis and um yes they can use taxis and this is something that we’ve uh tried to facilitate to address the uh challenges with uh transport next and everything including Psychotherapy supervision balent group postgrad
Everything is online the second unfavorable Factor was social life in Lincolnshire we came across we uh badly with social life with trainees complaining about zero night life Lincoln Shire is too empty small City nothing to do too quiet sleepy Town well this is uh something that we
Have little control over we can’t build a a shiny night club um but but I suppose it’s about celebrating what we do have we are a beautiful uh you know County which has a lot of um Countryside and it’s about um celebrating the aspects of the country that’s beautiful
Perhaps walking in the countryside and cycling and so on next loneliness about one-third of the trainee said that they felt more lonely we’ve tried to address this by organizing social events mentors for traines both consultant mentors and peer mentors next where we came across as favorable a
Small margin of P of trainees felt the housing cost and cost of living was much better 52% next what was another favorable factor was 91% of trainees felt that the workload and work life balance was much better than the when compared to the neighboring trusts next with 87% of the trainees felt that
They’ve had more support uh and most better support from supervisors in Aras than in previous jobs next so that we know about the nhse program in addressing inequalities in Rural and coastal areas they’ve looked at three areas I’m going to focus on the first one which was widening
Participation in and access to medical school with the ambition of increasing applications from rural communities in Lincoln in 2018 we started the Lincoln medical school we have the Lincoln um Training Academy which does inreach to the schools in the east coast trying to recruit uh students to medical school
But this has been complex because of social issues because of difficulties with tuition fees and travel and so on next what has really made an impact was changing changing the uh training post in rural areas so there was a redistribution of training post so that the training posts are all not London
Centric and we had the opportunity to expand our training post which we really took so we’ve gone from having 26 traines to having 46 traines we’ve doubled the number of Cs triple the number of St trainees and why is this important this is important because what
We know is 50% of trainees who uh of doctors settle within 50 miles of a medical school 80% of our St trainees are likely to choose consultant jobs 50 miles of where they trained and 50% within 10 miles this is very important in addressing the issue of Recruitment
And Retention and because we’re growing our own doctors and building our Workforce for tomorrow we’ve started seeing the benefits of that last year we were able to recruit three STS into consultant jobs fingers crossed this year we are hoping to recruit three more and of course leps have to adapt to
Issues with rurality to challenge with rurality like transport uh making our placements more attractive supporting our Educators with robust job learning and having Educators forum and protected time for them to offer supervision opportunities with research we have our research development Forum in collaboration with Lincoln Lincoln um
University and so on next but all of this is it is at its early and developmental stage what needs to be done is p trainees who do placements in a rural Mental Health Care trust need to have an understanding of the mental health care needs of the of the
Community in which they live in and understand how to work with them this has to be included in the curriculum and incentivizing Educators not with London waiting but east Lincolnshire waiting for uh uh trainers who work in a colle trainer colleagues who work in East Lincolnshire is important we know that
Uh remuneration is a very powerful incentive next in conclusion I think that there is significant inequalities in the provision of mental health uh care in Rural and coastal regions and a very uh the strand of growing our own doctors and the medical education strand in in addressing this
Problem is a very very important Strand and the end the steps that the NHS England have taken is certainly certainly in the right direction it feels that we’re not where we used to be but we’re certainly not where we would like to be thank
You okay so I’ll move on to the um next speaker who is Dr greenall Dr greenall is a consult psychiatrist working in Lincolnshire partnership NHS Foundation trust he’s been a consultant psychiatrist um who he’s a very psychologically minded uh consultant psychiatrist who has a special uh interest in trauma informed
Care he works in the women’s Ward and he’s also a very passionate educator and he’s the associate Clinical Director so and and a delightful colleague so over to Toby thanks so much P there and uh welcome everyone I just wanted to give you everyone a brief rundown of my
Training experience I had a a split training experience I did core training in London and then moved up to to Lincolnshire in the East Midlands for my higher training um so we just wanted to give a flavor of some of the challenges some of the some of the positives uh and
And and negatives of of that experience um to highlight some of the areas uh that we could focus on so as I said I did uh core training in um in in London um lots of great opportunities there with t terer Specialties and specialist Services a very strong sort of
Psychology provision um and I had some great sort of psychoanalytic experiences that really provide the Bedrock of my future practice so obviously a lot of funding and money and research um in London um that that is is difficult for us um to to match in in in the regions
Um and particularly Rural and coastal areas um and I think increased competition as we saw those incredible statistics of of sort of differential um competition rates um that really I think plays out in in the trainees um and and and perhaps leads to a slightly different energy in in the training group not
Always bad I think some people are attracted to perhaps you know less competitive areas for for good reasons around sort of work life balance but but it certainly was was a different energy um of course experiencing Urban Psychiatry with a more transient group certainly higher rates of psychosis more
Diverse um and and busy inner city hospitals um gave me a really good grounding um in terms of my training in core training and but was busy was hectic was was stressful at times and so I started to think about about a transition um I was starting to feel you
Know that that sense of a transitional sort of a transient population um meant there was not so much longitudinal followup feeling a bit lost in large organizations and and looking for some space to grow and work life balance and of course cost of living in London is always a
Challenge so I took that the decision to transition um I felt that I didn’t want to be a consultant in London and wanted to transition for higher training to start understanding the region um and understanding where I might be best placed um and very luckily I was placed
With beina as my first educational as clinical supervisor when I moved up to Lincolnshire that that idea around sort of better quality of life more consistent lifestyle I think and there of hecticness that you can experience in in urban areas that I I was looking for something more consistent to really sort
Of build my build my career and and build my family um as well I think there was a felt much more flexibility of options I think my experience in Lincolnshire was an organization that was really Keen to make the experience a good one and so was willing to sort of
Focus on my nurturing on my growth in my career both professionally and personally and I think it’s an important thing to think about if you’re someone that is trying to attract trainees to to your area or attract um Medics to your area thinking about you know what is the
Unique selling point of your area of your organization B always says you know if life gives you lemons make lemonade and I think it’s a really good point we can sit there and say what we don’t have what we’re not in Rural and and remote areas but actually there’s so much that
We do have and are we are we shouting about that are we attracting people that that where those things are are really real pool factors for them um as be is mentioned you know Lincolnshire is is a large rural County with a a low population density that
Does mean there’s a lot of traveling and a lot of driving in particular and trainees that we have that can’t drive it is always a bit of an issue um with the lack of public transport um but a big variety of people lots of diversity and social class with
Pockets of poverty significant poverty and deprivation has been as mentioned of course you know there is some some big cultural differences that I certainly was a bit of a culture shock um ethic diversity is obviously low there is a much slower pace of life and that’s sort
Of Separation with the age groups you don’t get so many people perhaps in my age group sort of younger professional um working uh age group it’s more sort of younger and and much older which has been a challenge I think one of the biggest things I I noticed when I moved into
Rural area was the staff group being so different uh much more drawn for the local community that did sometimes create some challenges is where staff and patients uh knew each other or had lots of connections um significant number of International Medical graduates and adapting to adapting to
That was was was a really important um aspect um lots of amazing sort of cross-cultural um exchanges and but also some some challenges as well um and then I think just differences in presentation uh in terms of rural rural um Mental Health problems H and perhaps more complex trauma more personality difficulties
Less psychosis which which I found really interesting and and and and exciting and but it was certainly different and I think in terms of access um you know nothing is right on people’s doorstep there’s always going to be challenges that increases you know those Health inequalities reduces access to to
Community Services um and and and obviously a lot of professionals that we can struggle to attract to rural um areas meaning less psychology for example but I really enjoyed building some great relationships collaborating connecting with people connecting with the wider Community suddenly feeling a real part of the community and and
Starting to sort of embed myself in that Community not just in in work but also in in in in in my personal life and I think the two were much more in tandem than they had been when I was living in London some challenges certainly reduced
Anonymity as I’ve mentioned I I I came across people or was connected to people that I was um that I was treating uh and that that was an interesting experience that’s so different to a big city where in London where you feel very Anonymous um Workforce challenges as I’ve
Mentioned with the medical Workforce um and you know hopefully events like this can help ATT trap people into rural areas but but it but I think you know Medics on the whole are sort of urban Urban creatures a lot of the time and and persuading people of the the joys of
Rural Life can be a challenge I think it’s really important to recognize that opportunities don’t always fall in your lap in in in in rural remote areas but if you go looking there is so much out there there’s an abundance of opportunities that’s certainly what I recognize I think I do really recognize
Sort of my intersectional privilege um and and the ability to sort of make the most of of the situation um that not everyone has but as a as a gay man sort of leaving London that was certainly a bit of a culture shock for myself so that’s been
An interesting process as well I think there’s always going to be pros and cons you know isolation and and so struggle of connecting with colleagues when services so spread out is always a challenge as well um but but there’s been lots of positives and lots of Joy
Uh as well in in making new connections of course what we all do this for is working with patients and I and I think that’s been the one of the great Joys has been those long-term relationships longitud seeing the longitudinal growth of patients and really feeling your impact in a way that
I think I I struggled to do um in in in London and I have really developed professionally I’ve had amazing mentors I think those statistics about people having more time for you H is absolutely true um time and space to grow and develop connect with people across the organization um where where everyone
Just has that little bit more time and space for you um I feel like I have been able to sort of find that space for my family and myself to grow um and and again sort of connecting with the community and feeling that sense of place um and sense
Of community has has been a real Joy so that’s a bit of a a Whistle Stop tour I think like I said it’s a a personal choice for everyone um and but but I think you know trying to encourage people Thinking Beyond the obvious of of what might attract people to Rural and
Remote areas um is really important and the opportunities are there for the taking um and and I really encourage everyone to to sort of strive for that I just want to leave everyone with a bit of a a poem perhaps we may not have time
For me to read it out but it’s a beautiful poem about uh taking a the different path um and how that um Can can have a profound impact on your life um so I’ll leave that with everyone and thank you so much thank you Toby
Thank you so much okay uh we are the next a talk is going to be living our best training life remote and Rural so we have Rosemary Gorden who’s an st6 traine in southeast Scotland she was the previous chair of the PTC she’s current Vice chair of rcy in Scotland careers and Workforce
Comm committee she’s keen on improving the experience of traines and we also have Dr Brook Marin joining us bro is a ct2 on who’s working who’s doing the west of Scotland training program she said this doing this training program has allowed her to travel far and wide most recently she
Traveled to lock Gil ped which has led her to develop more of a passion to promote uh the benefits of training in rural locations so over to Rosemary and Brook Brook I hope I pronounced that uh Place correctly thank you over to you perfect thank you just wait for our
Slides next slide please charger so I wanted to start by kind of talking about why we got asked to speak here today and I got to say I got the email asking if we would speak at this event and I went but I work in Edinburgh Edinburgh is not the more
What um but actually lots of my jobs have been in the borders both in my GP training and um in my Psychiatry training I live in the borders I have moved an entire six miles away from the house that I was brought up in um and I absolutely love working and
Living in the borders and actually plan to take up my consultant Post in the borders in the next couple of months but Scotland itself is relatively their all but there is differences kind of throughout the country so I thought it was important to Showcase Scotland as
A whole um so asked brick if she would kindly um join me today to talk about some of hard experiences as well so youve got a bit of a core training and higher training feel to our talk today but I thought I just would start by putting things in perspective a little
Bit and next slide please so geography was never my 4y at school but I thought I’d have a little look at actually where do we fit in the side of things and everybody always Compares everything to London so London has a size of 67 km
Squared now as you can see in that Frost pie chart that is a tiny amount compared to Scotland and actually both the health boards that we’re talking about today so the borders is almost 2,000 km squared and the Highland is over 1500 kilm squared and in comparison the population is basically
Inverted um so the Highland population has a population of 32,000 and the borders has a population of 115,000 Scotland as a whole has a population of 5.45 million now that is compared to London’s 8.9 so in area we are very vast in number we are quite small so that’s just
Kind of to put things in perspective next line please next slide so what are we going to talk about so I’m going to talk very briefly about my training journey in soue Scotland and Brooke is going to talk about her experience in NHS Highland and then we’re going to
Spend the majority of the talk speaking about the mot neuro b bs so actually why we genuinely think that training in the mot neuro areas is a fantastic training experience why you should certainly think about it and hopefully putting to bed all the mths that people think about
Oh no I would want to do that because um next slide please so this is literally going to be my two minutes on my training Journey um so as I’ve already said I was a GP before I went in into sight traing um and tomorrow is my last year of ledge
Before I take out my consultant post so I have a lot of years of training in southeast Scotland a lot of which has been in the borders but in particularly going to focus on my higher training um of which my st5 and st6 were both in the Scottish borders I absolutely Ador these
Years I got to see lots of different pathology I got involved in lot lots of things both within Scotland and the W UK um and I got to see how actually as a consultant I could work in an area that is so big but sure that my patients get good and appropriate
Care we spoke a little bit about digital literacy earlier and certainly my st5 we did things like my cpns would go out to IM mouth um and Cold Stream which is practically kind of sitting on English borders um and other CP go kind of people which is almost Ed at really as a
Vast area and we would do teams calls so often this was my addictions job so my patients they you know deprived areas deprived patients didn’t have the accessories and have the laptops the phones to do video calls but we would take that to them and actually we really were Innovative with
The technology and how we make sure that we care for our patients we have dropping clinics in all the big towns once a week and and when I say big towns I’m talking about like populations of 10,000 people and although Galla Shields does have a nightclub I have never been
In it but it does have a nightclub and but the things that often feel like the challenges aren’t they are opportunities to change things to get things done there’s minimal their te in a small Health Board compared to a massive Health Board it is so easy to
Try and push something through to make things better for your patients to look at those things that many people would call obstacles and go actually what can I do about that let’s have a joping clinic let’s set up an IT Cafe there’s so many things that we can
Do um and you do get to see a little bit of everything so I think back to my st4 clinic and my first patient would have an eatting disorder my next patient of the day would have a schizophrenia my next patient a bipolar the next patient a personality disorder um my next
Patient might have a borderline LD my next patient might have a forensic history you see a little bit of everything in every day and I think when it comes to Psychiatry you really are generous um within your speciality so I suppose my take home message from my training is that I have
Had so many opportunities and such a fantastic experience during training that I wouldn’t think about going anywhere else to take up my consultant post and I would urge other people to consider thinking about going somewhere the M NE where you genuinely become part of the team at such a junior stage you
Get opportunities that you would never get elsewhere even kind of thinking back to fy1 fy2 in District General hospitals getting chest stains LPS and things that nobody else would get into kind of uh Co training in Medical Specialties there are so many opportunities and it’s a fantastic experience next
Slide yes so thanks thank me I was just going to chat a we bit more about core training and sort of remote and locations H so I think um part of being on statistics of where most people stay where they went to medical school so you
Know I went to medical school in Glasgow and then stayed and wanted to do my core training in Glasgow um and then up came the opportunity to do a six months Post in l gil ped L I know that that was all part Still Still sort of part and pars
Of the job and I thought oh my God where is that so just to get bit of context um L gilp head is very far on the west of Scotland it’s part of ARG and but it’s about two and a half hours approximately from Glasgow and Glasgow being s your
Biggest by far your biggest city you know there is still shops and things but it is very brutal um so yeah so it was an interesting post and I think probably very unique and uncreatable elsewhere but if you can kind of all the map I
Just give you a rough outline of what I would do in a week and why it was so much fun so I would set off from Glasgow um this is a picture outside the art set off from glasgo on a Monday morning and I would then get a fedy so I would get
Get a fairy over to you can um probably see on the sort of middle bit of the map but so I would go over to but where I would do sort of a general adult Outpatient Clinic um I would do this with two of the CPN who have lived on
But for 20 years and they would pick me up from the faery we then go out we’ go do lots of home visits um the Island’s very small very easy to get around and you know I think you get a much better picture of patients in their own house
Compared to when they come to Clinic I think that’s very unique about sometimes every posts as you go to them rather than they come to you so yeah we’ set off with the the CPN we’ go around everyone’s houses and very so much Rosemary one minute you’d be visiting
Someone who’ be on the case load for 20 years just get freia next thing you know You’ doing an ADHD assessment you know sometimes you get called by the A&E or the police because there’s a drug induced psychosis on the island everything and everything would come through through you because you’re the
Only Port of Call um so yeah never a dull day never quite knew what you’re going in for and the island itself only has a population of about 4,000 so how people were still every week getting repaired to be seen by Psychiatry blew my mind but we were we were kept busy so
That was a Monday and then I would set off from but um and get another ferry so I get a fery around to L gilad which is the sort of main Hub of our and but Psychiatry um where the hospital is now the hospital was our base where all the
Trainees and all the consultants for the region are base so the team was made up of four consultants and then you had two qu Tres and that was it no higher Tres no no nothing in the middle between you and the Consultants so a very flat hierarchy very close team um very close
With the other core trainy as well and you know it really meant that the decisions fail to you you know you didn’t have your reg to run things by which could be quite daunting but also it meant there was just a lot more a lot more opportunities and I think you got
To experience a lot more so yeah on a Tuesday i’ be Gil ped do sort of impatient work um again I think when you go to these rural places I think Toby was seeing you get quite in mesed in the society and the community that’s definitely definitely true of um lot Gil
Ped interesting town you know it was one of the last asylums in Scotland used to have sort of a thousand beds so now down to 12 so everyone that was in the Asylum lives in the surrounding areas which leads to um interesting appointments in the co-op occasionally when you’re doing
Your shopping but yeah so I would do my impatient work with Tuesday and then from l gil ped I would travel all the way around to enveri a cup of coffee essentially to then work all the way back around to Dun and I would do spend the rest of the week
Doing clinics in dun and again just to highlight the unique opportunity you get there so look dun runs the only ketamine clinic in Scotland so you know I don’t know there any other courtes have got to do that in Scotland and again because there’s no r that was something I got to
Do it and really really enjoyed um so yeah finish up in Denon and then again I get fairy back to glasow and that would be that would be me for the week um and I do all over again the next G week and out of ours when you were on call I
Would cover the whole region so I would also cover cam down for Ellen um and M as well so it was really really interesting week so we were just going to that’s a brief overview of what the week was like and me we’re just going to quickly do um some Mythbusters about
Real training next slide please Georgia this was just my and these are just some pictures to give you an idea I mentioned the hospital so the that’s the Asylum which is still very much on the site um and then down sort of down the grass they’ve got they built the new
Hospital um so you’ve got the you’ve got all the social Psychiatry history and action when you’re physically on the site and next slide Georgia and then next one again yeah next again so yeah just for some Myers to finish off so I think people were highlighting here earlier you know some
People think in M locations there’s nothing to do which I can see how you can think actually you know our G of VI is absolutely beautiful there was walks everywhere there that was my this picture of my yoga studio that used to go every week um there’s a picture of a
We there was a local woman Polly who ran like a coffee a coffee shop place that everyone in was home went and there’s a picture you may may be mistaken for thinking it’s Australia but actually that’s in gide the fairy terminal that’s the heated outdoor pool that I used to
Go to after work once I’d been on the ferry next slide Georgia um yeah this is just some pictures from but so there was a glorious day on but where none of the patients wanted to be seen they all called in and canceled an appointment so
I got to walk around but uh this is Mount Stuart house where Lindon McCart where Stella McCart got married um so there’s always gems to be found in all of these places next slide next slide please yeah and the tra traveling is terrible I think we’ve heard a lot today about commutes and
Long distances but I I loved traveling around Scotland you know who who else gets that’s my that’s my money on the fairy I love the fairy other pictures um from the drive up to D I used to stop and have we walk on the way up so I I
Think sometimes these things are how you view them I don’t think having a long commute is always a disaster no honestly next yeah and I think is going to do the next few MythBusters so I think there’s a theory that there’s no good Psychiatry that actually to get that
The goodgo forensic psychosis you need to be in the middle of a big city like London and that’s just not to lots of these places have tons of deprivation they have a lot of aders childhood events and actually as much as there is this kind of city pool with major um
Psychi diagnosis we do see plenty um and that is all that variation as well so don’t think that actually going to the m neural places you won’t see the things that you do in big cities don’t think that it’s not as interesting because it certainly is um and often a
Lot more of that comes to you because it doesn’t go to third sector and you also get see things before they get unmanageable you get to do early intervention you get to re know your patients and that is incredibly important um next slide so I think similarly there’s this
That you become Des skilled and you certainly don’t um you see everything and everything because there aren’t tertiary centers you know we’re not sending our patients 400 miles away because they haven’t eaten disorder and they need to see the tertiary Center for it all of this stuff gets done within
General adults so eat disorders patal personality disorders neural developmental psychosis and you have the mix of kind of inpatient and outpatient so most of the M Neal areas in Scotland still hav an patient outpatient mix when you’re a consultant um on the whole we have Beds which is
Wonderful um so none of my patients sit in anes for 24 46 52 hours um most people get a bed very very quickly and hopefully kind of within the area set in the borders I don’t remember the last time we genuinely didn’t have a bed for a patient so there’s lots of
Opportunities and you don’t become deskilled um you just have a much wider um Baseline knowledge of things and we still you know we’ll send patients to dunde which is our Advanced intervention service or the mods L if need be and finally there are no opportunities so personally I think you know working in
These areas is an opportunity in itself but there are hundreds of opportunities there are less to need so actually you get more support you get to design your own training so at least sus what your educational needs are you have much more input in where you’re going to get sent
What you’re going to do and there’s all these other things that you can do you know lots of my friends have done phds um not my bag at all but lots of my friends are doing phds there’s lots of opportunity for research I became chair
Of the PTC I talk at things like this I’m speaking at Congress um I do lots of educational things I teach are Advanced nurse practitioners no matter what your kind of outside interest is within um medm where it’s education research leadership there are opportunities in all of these places you
Just need to ask for them um so I think that is our methbusters um we are more than happy if anybody’s got any questions about either our own experience of um theot neurom medicine or working or living in Scotland then um Georgia has a contact
Details so you can send us a email that is not a problem um thank you thank you Brook thank you uh Rosemary it was really important to uh you know to address those mths to really really bust them thank you so much um and now we have a recording this
Record recording is a rural Psychiatry road map by Dr Steven bfre he’s the director of training for Rural psychiatry in Western Australia so over to uh Dr Steven hi there my name is Dr St buari I’m a rural psychiatrist in Western Australia uh and the southwest region of
Western Australia thank you for inviting me to your webinar today I understand you’ve already been hearing for some um hearing from some uh excited rural people trying to promote the advantages of working in the rural areas um we’ve been doing a large body of work here in uh Western Australia to increase
Training opportunities and I’m going to spend the next 15 minutes just explaining to you our journey on how we got here here um before I do that I would like to acknowledge the traditional custodies of the land um of the officers here in bumbury thei of this past present and
Future um so our journey um in um working on increasing rural training opportunities in Psychiatry began uh with with a big body of work from our bational College the royal Australian New Zealand College of psychiatrists they they did a a wide ranging stakeholder engagement to try and lay
Down a road map to try and address the issues um of of having less psychiatrist in rural regions in Australia uh in 2021 they came up with uh the rural road map which is a really uh good document that outlines the actions required across both the college but also
Government um and health service providers in how to increase um those opportunities as I say um happy to share that document with you guys um basically it works on trying to fill in The Missing Link in rural areas of Western Australia in other parts of Australia and New Zealand we have medical students
Um we have interns we have Junior medical officers and we eventually have some R psychiatrist though we’d like more and we we we really need to plug the Gap so we have this what we’re calling an end to- end training program because we know that if we train people
In the country they’re more likely to stay in the country uh in the road map they identified this rural cycle cycle of rural disadvantage um and so we can see um that it’s a bit of a toxic cycle where there’s in inequity of access to services and poor rural
Outcomes um that that is contributed to by having a metr Centric medical education system under investment in Ral Psychiatry and training and supervision which means you have few trainees which means you have less access to Services similarly underinvestment in Services fewer opportunities overk Workforce chronic Workforce shortages which again
Leads to inequity of access um during the pro pro the process of us picking up this road map we had a look at rural wa specifically we did a lot of data did a lot of look at um the numbers and we could see that sis 100,000 people across
A number of different countries in Australia it’s about 13.7 um and in Western Australia in total it’s 13.5 but in rural wa outside the metropolitan area there’s only 6.3 caches per 100,000 people so that was giving us the impetus to do something about that we most of you have probably seen
This before a map of Australia and New Zealand we uh have on the back of this rural road map set up a dedicated rural training Zone um which is everywhere outside the metropolitan area within Western Australia which is which is a vast GE geography there’s 200 2.5 million square kilometers in rural wa
There’s only about 500,000 people um so we in um the start of last year 2023 set up a Ral training program and we have sites dotted across that that Western Australia where we have trainees and and I’ll dive into that a little bit more in
A minute but if we just zoom into the Northwestern tip up in broom you may have heard of um this is an example of a document that we put together in what we’ve done to um promote rural training we’ve done a we’ve done a a um showcase of each of the regions
And so this just sort of gives you a zoom in and understanding of the place and you can see that the distance between broom um and Perth which is the metropolitan area is about is is you know two 2,200 kilm which is the equivalent of London to Athens um if you
Go further away up into Windam where the population is quite small um but there are patients to see um that’s 3,200 km from Perth um and me being the director of training for a rural training zone now I have trainees up in broom um that
Are over 2,000 kilm away from me um and so I’m traveling up to see them which can be exciting um so more of the data that we put together when we were trying to justify um both accreditation for a rural training Zone but also funding sources we were we used a national
Mental Health Service planning framework to work out exactly how many um psychiatrists are recommended for rule wa which we came out with a figure of 69 across the seven different regions um and we only currently have 26 so we need we need a fair bit more um
And then also highlighted that only 54% of um the established positions actually filled with permanent staff and that 47% of the workforce is actually locom or contractors um we were identifying that um the Metro Centric training program that existed in um Western Australia and and a number of
Other places in Australia similar um uh had its limitations in its ability to um service and populate the rural regions with um Psychiatry trainees and and and the medical Workforce um most of the wa trainees prior to our training program weren’t completing rural terms um and even if
They did they’d often come for 6 months and then return to the city um we we identify the of the 50 who had graduated in the last five years only four of them ended up becoming rural working in rural wa um there’s been a strong interest in
Training but as you can see here very briefly that there was a we have a lot of applicants into training um into psychi specialty training but only um a small number of those actually get into the training program so the um yeah so we going to do something about that so
When I started in this role in 2021 and on the back of the rural road map you can see we had a number of this just demonstrates that the number of accredited training posts that we had and we we put a concerted effort into increasing the number of training posts
That were available and accredited by our College um unfortunately you can see that they weren’t all filled though on the right hand side they’re only filled by in sometimes only half of those accredited posts and then even when we increased our number of um accredited posts that didn’t necessarily then
Unlock an increase in trainees into those Positions the journey from there to now is a bit of a whirlwind tour to be to be fair we’ve done a lot of work um in our um wa country Health Service which is wax um we have been lobbying at multiple different levels um through government uh through college um and ended up
Basically in a journey over the last two years um to have our own fully fledged rural training program um so once we got accreditation that was one part of the journey the next part of the journey was more around uh how do we fund this we’re going to
Who’s going to pay for an increase in number of doctors um and so we were quickly able to identify that there actually already are doctors seeing um patients in rural plac in placements but they were predominantly locom and expensive ones at that and so we were able to identify that for one locom
Psychiatry register we brought a trainee and it was much more cost effective and over three years in in one particular region in the southwest where I’m from um we could save over a million dollars a year um rather than sort of banking that savings we were able to see that
And increase the number of trainees in that region significantly so this demon this this slide here demonstrates that that we um were’re able to after we started our program in 2023 you can see the numbers have jumped up for an average of about uh six or seven traines through 19 2021
And now we’re looking at for next semester starting in two weeks time in February we’ll have over 30 traines working in outside of the metropolitan area in Western Australia which is really exciting as I said we’re broken up into seven different regions here in wa um we we have trainees um based in
The bigger centers where they can do uh we’re calling them now comprehensive training hubs where they can do all of the five year fellowship program that our College runs um in Albany Brom Geraldton and bumbury and we also have some other opportunities in smaller sites where trainees can go and do some
Of their training uh we did a lot of work in um in the promotional side of attracting people to our training program and it’s already over subscribed but we did a lot of work in uh like I mentioned at the start showcasing each of the regions and
What they’ve got to offer and we created a document um of a program overview um which which outlined for for trainees who may want to come to us uh the advantages of coming to those regions and so this is just a snapshot of that um which I’d be happy to share with you
Guys as well if you wanted to use that um then the final piece of the puzzle I guess is we we’ve got those train now um we’ve increased significantly and now it’s about the product and and the support that we provide people in rural regions because we understand that there can be things
Particularly over the vast geography of Western Australia the isolation that comes along with that and so we are really committed to supporting the trainees and their families when they come into rural regions and we’re aiming to foster a positive and supportive culture um we’ve we pretty big on
Pastoral care we um have lots of supports and lots of different contacts we’ve set up dedicated WhatsApp groups for example for the trainees to contact me as their director of training um we hold regular monthly video conferencing Town Hall meetings where we can talk to them about progress and exam supports
And things like that um we’re really big on that support both for the trainees but also for the supervisors because we’ve we’ve we’ve increased the the Reliance on supervisors in rural locations significantly as well and we want to support those guys um we’ve got lots of independent support and crisis
Pathways we’ve got lots of peer support and mentoring um we have very attractive accommodation and relocation packages to support those guys it’s could be quite expensive moving to the country um uh lots of Education support lots of resources and um probably the uh the jewel in our Crown at the moment is our
Orientation program we are flying our trainees that are now will be 30 um across the the state into Perth at the start of the year for a weekend that is um equally networking and social events as it is educational and training support um so these guys can come into
The city meet each other network and then continue those networks when they go back out into their regions for their training semesters and that’s been really successful it’s great fun everybody looks forward to it and it’s actually drawing trainees to our training program um though I thought 15 minutes
Wasn’t a long time I’ve um finished on time thank you so much for the opportunity to talk if anybody wants any more information on what we’ve been able to achieve here in rural wa um my email address is is there um feel free to contact me um and and happy to answer
Any questions thank you very much absolutely mindblowing mindblowing account of the extent of plan the strategy that’s gone into it and the way in which it’s been implemented and the scale in which it’s been implemented quite inspiring actually so a big thanks to Dr ble bfy Dr Steven bfy and his
Colleagues we have a lot of lessons to learn from them also big thanks to Toby Toby your experiential account on on on transitioning from a city boy and finding a fulfilling work life balance and a work life and a personal life in rural Lincolnshire is really really a
Testimony to what we’ve been saying along and rosemary and Laura brilliant account uh lovely Rich narrative on busting the myth about training in rural areas I don’t see anything in the question and answer section except what sub’s written about accommodation relocation packages look like is it only for trainees or trainers to
Ah well it’s um I think it varies from from trust to trust doesn’t it um uh we used to have an excellent relocation uh you know a specific Recruitment and Retention uh package but uh because of uh Financial pressures that’s been taken away um I think that is that varies from
Trust to trust anything else that Toby or Rosemary or Georgia wanted to add to that comment because that is important that goes back to the point that we been making about incentivizing um trainers and trainees and that’s that’s important any anything to add I didn’t know whether was maybe
Referencing the Australian example it’ be interesting to get the figures and see how comparable it is to the packages that are available um here in in in the UK absolutely I think we we we want to keep in touch with them and learn lessons from them including looking at what they offer
Absolutely so I I hope the takeaway message is that training in uh Rural and coastal areas can be very fulfilling uh emotionally and practically and in every way and there are lots of op opportunities and um yes yes it’s um that’s that’s the takeaway message I
Hope people are open to that thank you everybody thank you