Rural health care in the U.K.: a rapidly changing scene

Delivery of medical, nursing, and other health-related services in remote and rural areas is challenging. Historically, in the U.K., rural health care delivery has focused on medically qualified general practitioners or family physicians providing primary care services, together with isolated small hospitals providing limited specialist services such as surgery, obstetrics, and internal medicine. However, three recent developments in Europe and the U.K. will change these traditional practices. These are implementation of the European Working Time Directive, constraints related to "clinical governance", and a new contract for general medical practitioners. Delivery of services in rural areas currently faces potential conflict between national standard setters and local practicalities, and re-design of services is required. Public engagement with redesign is essential, but the outcome may be dependent on the methods used. Evaluation of new services is essential. This article gives brief examples of: two public engagement processes (a survey and a discrete choice experiment), two redesign experiments related to screening for aortic aneurysm and consultant-supported care in an island hospital, and some issues concerning the use of new technologies (telemedicine and telephone triage) in remote communities. Future implications are discussed.