Table 3.

Essential service requirements and environmental enablers for PHC models in rural and remote communities

CONTEXT Rural-Remote continuum	SERVICE OPTIONS	Environmental enablers			Essential service requirements
		Supportive policy	Common-wealth State relations	Community readiness	Work-force organis-ation	Work-force supply	Funding	Governance, management & leadership	Linkages	Infra-structure
RURAL (Characterised by larger, more closely settled communities)	Discrete eg: 'Easy Entry-Gracious Exit' model	The option for discrete primary health care services exists because community population catchments are sufficiently large to support them. The role of environmental enablers (while important) is less influential than in remote communities, and essential service requirements are more easily met even though supports are needed to address some aspects of services (such as workforce recruitment and retention).
↓	Integrated eg: Multi-Purpose Services, Shared Care, Coordinated Care models	The need for service integration increases in order to maximise economies of scale and efficiencies in communities where individual services or competing services are not sustainable; single point of entry to the health system through locally available access pathways is important to co-ordinate patient care and reduce the need for patients to travel extensive distances; and maximise the range of locally available services.
	Comprehens-ive PHC eg: Aboriginal Community Controlled Health Service model	This option ensures a comprehensive primary health care service is available in small, isolated, high-need communities where there are few, if any, alternative ways for delivering appropriate health care. The need to ensure that environmental enablers facilitate the delivery of appropriate care, minimise cost-shifting and duplication of activity and reporting, and maximise community participation in the service development are paramount. Flexibility in meeting essential service requirements is essential to take account of local needs and circumstances.
REMOTE (Characterised by small populations dispersed over vast areas)	Outreach/Virtual Outreach eg: Hub and spoke; Fly-in, fly-out; Virtual clinics; Telehealth models	This option addresses the health needs of communities with populations too small to support permanent local services by providing access through virtual or periodic visiting services. Opportunities for community involvement and management will be more limited than with locally-based services, while co-ordination with any existing services is critical. Outreach models often co-exist with other model types- discrete, integrated and comprehensive PHC services.