Rural general practice: a personal view of current key issues.

We know much less about health care needs and provision in rural areas than we do about urban areas, particularly the inner cities. Although rural areas are attractive, isolation and lack of accessible services create problems for residents, particularly for those without transport. Analysis of the problems is handicapped by the lack of generally acceptable definitions of the meaning of rurality and remoteness. Rural deprivation is not reflected in commonly used indices of deprivation and is often "hidden". There is a shortage of general practitioners and concern that the situation is deteriorating. What does this mean for the future? Should there be a 'rural track' in educational programmes for rural health workers? How can we harness telemedicine to improve communication between rural dwellers and primary health care, and between primary and secondary health care? Where will nurse practitioners fit into the picture? If centralised services (e.g. for accident and emergency) lead to higher quality of care, how can rural dwellers have equitable access? Some possible solutions are presented.