Ulcerative colitis (UC) requires coordinated biopsychosocial management, yet rural primary care often faces gaps in monitoring, mental-health (MH) assessment, cardiovascular disease (CVD) prevention and access to specialist IBD services. Previous local audits revealed inconsistent treat-to-target (T2T) practices, limited patient confidence in flare management and poor awareness of faecal calprotectin (FCP). Alongside this, UC is associated with elevated atherosclerotic cardiovascular disease (ASCVD) risk and substantial psychological burden, both of which may be under-recognised in real-world primary-care workflows.To integrate findings from four complementary evaluations—mental-health screening, ASCVD risk assessment, patient experience of monitoring and access, and a goal-directed care model—to propose an improved, person-centred rural UC management framework aligned with WONCA, WHO and NHS long-term priorities.A convergent mixed-methods synthesis was conducted. Retrospective UC audits captured PHQ-9/GAD-7 scores, ASCVD risk factors, lipid optimisation and LDL-cholesterol follow-up. A cross-sectional patient questionnaire explored contact with IBD teams, understanding of T2T monitoring and self-management capability. Quantitative data were summarised descriptively, while qualitative free-text underwent thematic analysis. Findings were integrated using a goal-directed paradigm emphasising safety, function, psychological wellbeing and shared decision-making.MH screening had not been previously embedded; although most recorded minimal PHQ-9/GAD-7 scores, qualitative reflections highlighted anxiety, uncertainty and social isolation. ASCVD risk was high: 67% had QRISK ≥10% and 48% ≥20%, yet fewer than half received statins and longitudinal LDL-C monitoring was incomplete. Patient-reported experience revealed low access to specialists (76% not under hospital follow-up), limited understanding of FCP and T2T principles, and low flare-management confidence. Monitoring gaps (e.g., no recent FCP tests, limited blood work) were common. Across datasets, unmet psychological, educational and cardiovascular needs were consistently observed.Fragmented MH assessment, suboptimal CVD prevention, monitoring inconsistencies and limited specialist access collectively hinder high-quality UC care in rural settings. A goal-directed approach provides a coherent framework to integrate clinical, psychosocial and behavioural priorities.Embedding structured MH screening, ASCVD risk assessment, FCP-based T2T monitoring and shared goal-setting into routine UC reviews can enhance holistic outcomes and reduce rural health inequalities. Integrated pathways and tailored patient education are essential for effective, equitable UC management.