The current suspension of out-of-hours midwifery service for local births in Skye and Lochalsh has once again highlighted the profound problems in trying to ensure round-the-clock medical cover in the Highlands and Islands.
Three midwives off sick at the same time represents a real challenge to the health board. That body is still trying to find an answer to the chronic shortage of GPs in some remote communities.
Using locums is prohibitively expensive such as in Thurso where more than £1 million was spent on locums in the last year.
So now the health board is employing two salaried GPs. The quality of locums is also uneven.
But the board can't be accused of a lack of imagination in its attempts to hire GPs - from advertising on the back of buses in Leeds to employing the services of an advertising agency based in Jersey to promote Highland life.
Now we hear there is some more "thinking out of the box" with the development of a new post called a rural health and social care support worker.
The board hopes to make appointments soon and it will be piloted in the Small Isles. It plans to recruit support workers on all four: Muck, Rum, Canna and Eigg. They will probably only be required a few hours a week but will be paid.
They will be given training in a wide range of tasks, from removing and re-applying simple wound dressings to helping patients use teleconferencing equipment to talk to doctors on Skye.
NHS Highland has been developing IT links with a view to ensuring remote access to the Small Isles from Broadford and Sleat Medical Practices and MacKinnon Memorial Hospital at Broadford.
Telehealth facilities have been installed in the Small Isles Medical Practice on Eigg, and it is planned to have IPads available on Canna, Muck and Rum to allow patients, helped by their support workers, to access telecare.
NHS Highland has been from studying approaches to rural health care in Alaska and New Zealand.
The new support posts are also tailored to fit in with the new approach to GP cover for the Small Isles.
The health board been managing the GP service on the four islands since 2012, using locum doctors who were based on Eigg during the week. But it was expensive and unsustainable system that provided an uneven service across the islands.
So since the beginning of the year the health board has been managing a visiting GP service, with a doctor from Skye making the 12-mile boat trip to Eigg, the most populous island, every Tuesday and, on alternate Thursdays, to Canna and Rum, and Eigg and Muck.
Dr Angus Venters, of the combined practices of Broadford and Sleat on Skye, has led the way and he is about to be joined by a GP from Hampshire who will start in a fortnight. The third GP earmarked to help is going off on maternity leave, but will be replaced during the time of her absence.
The health board is clearly trying.
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