Cardiac rehabilitation

Rural practiceI grow increasingly concerned for the future of small rural practices, particularly those in the Scottish islands.There is a clear probability that as the GPs presently in their single-handed posts retire, they will not be replaced and primary medical care for the island communities will be provided by resident nurses with GPs visiting the islands regularly but infrequently (once a week or, more likely, less often).The effects of these changes will be twofold: they will save the NHS money (this is doubtless the driving influence) and they will radically alter the role of the doctor in the isles.No doubt the patients will be well and compassionately cared for by nurses, and the nurses will have at their disposal all the emergency paramedic and evacuation facilities.However, the traditional model of health care by a doctor-nurse duo, providing different and complementary skills, has been a very successful one and the standard of medical and nursing care received by islanders is exceptionally high.A nurse on her own would be hardstretched when she finds herself acting as both nurse and doctor.Many of the isles have, in recent decades, shown a worrying trend towards