'We're stretched and everything is miles apart' - Yorkshire doctord highlight challenges facing rural general practice
A doctor who has been based in the Yorkshire Dales for nearly 30 years has said it feels like rural general practice is “a bit forgotten”. Dr Jonathan Pain, a senior partner at the Central Dales Practice in Wensleydale, spoke to The Yorkshire Post about pressures in medicine in rural areas and said more financial support was needed to support surgeries.
He said: “Patients often have to travel a long way to come and see (a doctor). Access can be difficult if the weather is bad... There’s not much public transport...The government is very keen for us all to do everything online but the infrastructure here means we don’t have superfast internet and mobile signals are a bit dodgy as well...Because we’re (remote), getting deliveries of things is difficult as well. We’re a dispensing practice because there isn’t a chemist but getting the wholesalers to deliver medications can be tricky because of the distances and the roads coming to us.
“Plus, recruiting people to come and work here is getting harder and harder because of the way amenities are disappearing out in the country, things like pubs and schools, petrol stations, banks - things that people rely on...It puts people off coming to live and work here.”
The Central Dales Practice recently began operating a branch surgery from the site of the former Reeth Medical Centre, which closed at the end of May with the retirement of the doctor who ran the facility with his wife. Concern was raised by residents and local representatives over the long-term future of GP provision in the area and the distances that Reeth’s 1,600 patients may have to travel in order to see a doctor. A number of options were explored before the South Tees Hospitals NHS Foundation Trust signed a five-year lease for the centre, enabling Central Dales Practice to operate the branch surgery.
Dr Brian McGregor, a member of BMA Yorkshire Regional Council and medical secretary at YORLMC – an organisation for NHS GPs and practice teams across York and North Yorkshire and in and around the Bradford district, said it was a struggle for Reeth to recruit new GPs.
“One of the problems with rural practice is there are not GPs sat around looking for jobs,” he says. “It’s very difficult to recruit. There’s a lot of uncertainty around GP partnerships too - income has been dropping for years, funding has been squeezed, expenses are going up and so there’s not a massive enthusiasm to take on a GP partnership, because of the financial risk involved.”
Dr McGregor, who works in a GP practice near Wetherby, said Reeth is “geographically distinct” – quite a distance from other providers, with travel affected during heavy rain or snow. “It’s got quite a clinically demanding workload because of the demographics of the patients and the nearest practices didn’t have much capacity to cover it,” he told the YP, adding: “If one (surgery) falls and additional strain is in place on the others, you could see all those fall as well”.
The South Tees Trust taking over the surgery premises made it “financially viable” for Central Dales Practice to operate a branch surgery, Dr McGregor said. But that’s not without challenge. Dr Pain explained: “We were already quite short staffed, a GP and a bit down.” Now an increase in patients and workload means they need another as well. “We’re quite stretched and not helped by the fact we’re very rural so everything is miles apart.”
Asked what support rural practices need, Dr Pain said: “It always comes back to money. The formulas used to work out how practices are funded are heavily geared towards towns and inner cities because they factor in deprivation – so that’s where the money goes. The formulas used don’t recognise the fact that out here there isn’t any transportation, people don’t have amenities and whilst there might not be deprivation to the same extent (as in towns and cities), there’s still a lot of people who are struggling because of everything costing more.”
A Department of Health and Social Care spokesperson said through £1.7bn of “investment and reforms”, it was “fixing the front door of the NHS and making it easier than ever for patients to access their GP by rolling out online consultation requests”. The Government said it was also reviewing how GP funding is distributed, looking at the Carr-Hill formula, which it says is “designed to ensure that practices are funded for their expected workload” and “accounts for unavoidable costs based on geographical area specifically the additional costs of delivering services in a rural area, and in areas where staff costs are higher”.