“No Doctor No Village”: An ethnographic study of an advocacy campaign for Rural General Practice.

Problem

“#nodoctornovillage” is a nationwide campaign to save and protect the GP service of Rural Communities in Ireland which has become increasingly vulnerable and has led to isolated rural communities losing their permanent GP service. These communities which predominantly serve very vulnerable and often older people are losing their access to what is a basic human right as enshrined in the Charters of the WHO and the UN; that of access to primary healthcare.

Approach

The researchers are all GPs living within rural communities affected by this crisis. Throughout this study, the researchers maintained relationships with people directly affected, participated in community activities and meetings relevant to the campaign, and took extensive and elaborate notes on the experience. In addition, the lead researcher undertook semi-structured interviews with a purposeful sample of those involved in or affected by the campaign. The data was analysed according to the principles framework analysis using N-vivo software. Themes were independently identified by two authors of different disciplinary backgrounds and a concordance of views on common themes was reached after discussion and debate.

Findings

This advocacy campaign has united many rural GPs and rural communities by a variety of actions from traditional town hall style meeting to extensive use of social media. The simplicity of the message and the directness of the threat to healthcare access felt by participants was identified as crucial components of the success of the campaign.

Consequences

Doctors have a recognised role in advocacy enshrined in Irish Medical Council guidelines and evident in everyday practice. Of necessity, at times this advocacy role extends beyond the consultation room and into the political arena. In this setting, the communication skills, empathy and collaborative approaches used in everyday General Practice can be effective.