Urinary incontinence is a very common condition, affecting up to half of all women and a significant portion of older men, with major impact on quality of life. In rural communities, limited access to specialist care makes management challenging. At our medical centre in Tasmania, we introduced a structured program of Complex Unified therapy to provide a non-invasive, practice-based solution. Between 2018 and 2025, 91 patients both men and women of varying ages and comorbidities underwent 228 treatment courses.Patients received either basic or maintenance courses. Outcomes were assessed at completion and during follow-up. A ≥50% improvement in bladder control was achieved in 62.73% of patients, including complete recovery in 6.59%. Less than 50% improvement noted in 23.68%  and no improvement in 13.9%.  Approximately half of patients sustained improvement for ≥18 months. Results were compared with published benchmarks for surgical and conservative therapies.Strengths included accessibility, safety, and patient acceptability. Active sceening program was implemented. No specific selection criterias were applied. All procedures were adjusted according to patients tolerance. Limitations in need for repeated courses in some cases. Lessons learned include the value of structured maintenance therapy, the importance of patient counselling, and the feasibility of delivering continence care outside tertiary centres. Future work will stratify results by age, severity, and comorbidity, and explore integration into broader chronic disease programs.Rural primary care can deliver effective continence management with outcomes comparable to international benchmarks.  Introduction of active screening program following structured therapy into everyday practice expands the role of general practitioners, enhances patient confidence, autonomy, and reduces inequities in access to care.Primary care is able to provide positive outcomes across diverse populations. Our patients can achieve effective bladder control, gain functional and psychological improvement, return self-confidence. This program required  minimal space, has affordable cost to establish and training available

Access to long-acting contraceptives is limited in rural areas of Canada and many countries, due to the paucity of trained primary care inserters. In our context pharmacists are able to prescribe all contraceptives, and all are available without cost. Could the pressure on family physicians be reduced if pharmacists perform insertion of subdermal implants in the pharmacy?We aimed to understand pharmacist’s perception of the potential feasibility, training needs, requirement for resources, readiness, and any barriers or facilitators, to implement sub-dermal implant insertion.We recruited community pharmacists representing the range of geographic regions of the Canadian province of British Columbia for semi-structured interviews. Our thematic analysis used an inductive approach, developing overarching themes after identifying experiences and perceptions.Among the twelve participants we learned pharmacists have strong interest to provide implant insertions. They identified in-person training, staffing support, consultation spaces that are private, adequate funding, access to a booking system and increased public and clinician awareness and support as facilitators. We also learned that pharmacists see physical space constraints, potential workload, liability concerns, care pathways for removal, and the potential for resistance from physicians as potential barriers. Participants emphasized the importance of affordable certification programs with options for ongoing recertification and that training should ideally be integrated into pharmacy education and existing continuing education training platforms.We found pharmacists assessed this practice as feasible, with a range or requirements to support implementation identified, largely relating to training and supportive infrastructure.Pressure on rural family physicians could potentially be relieved through task sharing of subdermal contraceptive implant insertions with pharmacists. Next steps will involve addressing regulatory, logistical, and interprofessional frameworks. Engaging pharmacists to support some primary care tasks has the potential to support family physicians in busy practice settings.

Community engagement is central to the principles of WONCA Europe, supporting equity, continuity, participation and community-oriented primary care. Rural populations often face additional barriers to accessing services, including reduced transport options, socioeconomic constraints and variability in health literacy. This project evaluated how structured, proactive community engagement activities can strengthen primary healthcare delivery, empower local populations and enhance health outcomes.Examine how a structured programme of community engagement, including patient surveys, community‑group attendance and collaboration with the Patient Participation Group (PPG), could enhance delivery, accessibility and responsiveness of primary healthcare services in a rural general‑practice setting.A mixed‑methods approach was undertaken. Engagement activities: consultations with the PPG, attendance at multiple community groups, a patient survey assessing interest in interactive health‑education sessions. Quantitative data were obtained from survey responses, while qualitative insights were generated from patient feedback during group sessions. Thematic analysis explored perceptions of accessibility, trust, preferred learning approaches and community priorities.Survey data showed high engagement, with 94.83% (n=477) consenting to participate. 80% expressed interest in attending interactive health‑education sessions. The most requested topics were blood pressure, weight management and lifestyle change. Preferred venues were local village halls (74%), with a weekday session preferred by 90% of respondents. The age distribution indicated strong engagement among older adults (42% aged 56–69; 32% aged ≥70). Qualitative findings highlighted trust, continuity and a desire for practical, relatable education as key enablers of community participation. Barriers included limited confidence in managing health conditions and uncertainty about what services were available.Qualitative insights showed that trust, familiarity and relational continuity drive effective engagement, with community-based approaches perceived as more personal and less intimidating than practice-based ones. However, barriers such as low confidence and limited awareness of services highlight the need for ongoing, adaptable engagement. Early outcomes were positive, but evaluation was limited.Meaningful, structured community engagement promotes trust, strengthens relationships and improves the responsiveness of primary healthcare. By involving communities as partners in the design and delivery of services, primary care can become more equitable, person‑centred and sustainable. Community‑based educational approaches offer a scalable model aligned with WONCA principles, particularly in underserved or rural contexts.

Rural-oriented general practitioners (GPs) are core grassroots healthcare workforce trained via China’s "Rural-oriented Medical Education Project" to address rural physician shortages and improve primary care quality, requiring 6-year mandatory service. They face limited career development and low retention (only 16%). Targeted CME can enhance professional identity and retention, but existing programs overemphasize clinical skills, misalign with practical needs, lacking systematic training needs assessment and factor analysis.Systematically assess CME needs priorities of rural-oriented GPs in Chongqing to identify key competency gaps; classify heterogeneous subgroups via Latent Profile Analysis (LPA); explore impacts of personal, professional, and family factors on needs types, providing evidence for targeted CME curriculum design and policy optimization.A cross-sectional survey was conducted (July-August 2025) among 508 rural-oriented GPs in 38 Chongqing counties via stratified sampling based on economic, demographic, and geographical conditions. Validated Chinese HHTNA (high reliability, assessing skill importance/proficiency) and a demographic questionnaire were used. Data were analyzed with SPSS 29.0 (descriptive statistics, regression) and Mplus 8.3 (LPA).All 37 skills showed significant training needs (p1.5); having one child was positive (OR=0.26-0.49).Rural-oriented GPs have widespread and heterogeneous training needs, with clinical research gaps mismatching current CME focus. Family responsibilities (e.g., childcare) divert energy, increasing needs; GPs with higher title/income have lower needs due to better resource access. A tiered, demand-driven CME system integrated with promotion incentives is needed. Limitations include self-reported data; future studies require objective assessments and longitudinal tracking.Rural-oriented GPs in Chongqing have significant competency gaps, with Clinical Research and Evidence-Based Practice as top priorities. A tiered, demand-driven CME system integrated with promotion, salary incentives, and flexible learning (e.g., online courses) is needed to ensure equitable resource access, enhance competence and long-term retention, supporting primary healthcare sustainability.

Responsed time in Out-of-hospital cardiac arrest (OHCA) episodes remains a critical determinant of survival, with outcomes significantly poorer in rural areas due to delayed emergency medical service (EMS) arrival. In the UK, approximately one in four patients achieve return of spontaneous circulation (ROSC) by ambulance handover, yet fewer than one in ten survive to hospital discharge. Community First Responders (CFRs), trained local volunteers, provide early support and can respond to any medical emergencies to help ambulance services within Lincolnshire, UK. Access to defibrillators (ADs) also represent a potentially life-saving intervention in time-critical circumstances and proposed as critical interventions to bridge rural-urban gap in emergency care. However, evidence on their economic value and practical impact within the UK context remains limited.To evaluate the accessibility and effectiveness of CFRs and defibrillators in improving OHCA outcomes in rural Lincolnshire, and to assess their cost-effectiveness within National Health Syestem (NHS) policy frameworks.A mixed-methods approach comprising: (i) a scoping literature review of AD-related quality-adjusted life year (QALY) evidence; (ii) analysis of anonymised data from East Midlands Ambulance Service (EMAS) and the Lincolnshire Integrated Voluntary Emergency Service (LIVES); and (iii) comparison of OHCA outcomes with and without CFR attendance. Key predictors included rurality, call category, clinical condition, age, sex, ethnicity, deprivation index, conveyance, and response times.CFRs attended 17.7% of OHCA episodes, arriving before EMS in 38% of cases. CFR attendance reduced mean response time to 7.45 minutes, compared with 9.19 minutes for ambulance crews. However, CFR attendance was not associated with significant improvement in ROSC or 30-day survival. This study economic modelling, informed by Smith et al. (2020), estimated incremental per-patient CFR programme costs of £203, while AD improves access but may exceed the £30,000 per QALY cost-effectiveness threshold, with estimated NHS costs of £22 million annually.These findings suggest that while CFRs reduce response times, survival benefits are limited and AD can provide cost-effective contributions to rural emergency care.While CFR reduce response times, they do not appear to improve survival outcomes independently. Nevertheless, both CFR and AD interventions may represent cost-effective strategies when assessed within NHS thresholds, particularly in rural settings.