Ulcerative colitis (UC) increasingly requires shared-care delivery across primary& secondary services, yet rural health systems face additional barriers including sparse specialist access, inconsistent monitoring infrastructure, and variation in capability. WONCA priorities emphasise continuity, equity, person-centredness, and strengthening the role of primary care in chronic-disease management—areas highly relevant to UC. This project integrated epidemiology, patient-journey insights, and healthcare-professional (HCP) learning needs to design pragmatic treat-to-target (T2T) maintenance& flare pathways for rural general practice.To combine real-world epidemiological evaluation, analysis of patient experiences, &assessment of HCP learning needs to co-produce structured UC pathways supporting personalised, equitable care in rural primary care.Three workstreams were undertaken.         1.      Epidemiology: A retrospective mixed-methods review of 64 adults with UC examined demographics, multimorbidity, disease-activity coding, biomarker utilisation, prescribing patterns, &referral behaviour. Qualitative free-text records underwent analysis to identify unmet needs/ barriers to care.         2.      Patient Journey: Longitudinal review characterised relapse patterns, corticosteroid exposure, psychological burden, delays in biomarker testing, and difficulty accessing remote gastroenterology services—issues disproportionately affecting rural populations.         3.      HCP Learning Needs: A digital questionnaire evaluated confidence, knowledge gaps, and preferred educational formats. Quantitative data were summarised descriptively; free-text underwent inductive analysis. Triangulation of the three data sources informed pathway development through multidisciplinary workshops aligned to NICE NG130, BSG guidance, &IBD-UK standards.The epidemiological review highlighted inconsistent disease-activity documentation, low utilisation of faecal calprotectin, and limited visibility of postoperative states. Patient-journey analysis revealed delays in recognising deterioration, inadequate safety-netting,& significant uncertainty about accessing specialist input. HCPs reported strong confidence identifying symptoms but limited confidence monitoring remission or managing flares; priority learning needs included differentiating inflammatory from functional symptoms, interpreting biomarkers,& safe steroid use. Integrating these findings enabled the co-design of two linked pathways:         •       A T2T maintenance pathway incorporating systematic biomarker-guided monitoring, structured coding,& optimisation of 5-ASA.         •       A flare pathway including early biomarker testing, rapid GP review, escalation criteria,& clear safety-netting information for patients.A coordinated, mixed-methods programme integrating epidemiology, patient experience, and workforce development can strengthen UC management in rural primary care. The resulting pathways support WONCA priorities by improving continuity, reducing inequity, and enabling person-centred, proactive care across the chronic disease trajectory.