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SUPPLEMENT function, responsibility and funding of the service, and at the same time allow flexibility. The Primary Health Care Access Program and the Aboriginal Coordinated Care Trials are examples of approaches that have allowed for cashing out and pooling of funds in order to meet specific circumstances. 11 Concurrent with this flexibility, local community involvement with planning, development and evaluation of a service is crucial to ensure acceptance and harmonious working relationships and to maximise the use of services. At the micro level, several specific service requirements must also be fulfilled. These relate to workforce organisation and supply; funding; governance, management and leadership; service linkages, and infrastructure. These factors are closely inter-related and interdependent. For example, recruitment and retention of the health workforce becomes much less of an issue when adequate infrastructure, good management, professional development opportunities, clear role delineation and a supportive critical mass of practitioners are developed.

Policy implications Effective and sustainable rural and remote PHC models provide consumers with access to appropriate quality care within realistic cost constraints. Our review identified a number of critical policy issues relevant to the provision of sustainable primary health services for small rural and remote communities. Firstly, the inter-relationship between the essential service requirements of sustainable PHC services highlights the need for a systems approach in which components of sustainability are identified and their inter-relationships measured. 8 Focusing solely …