A plan to ensure the survival of Scotland's rural hospitals was published by the Scottish Government yesterday.

Health Secretary Nicola Sturgeon unveiled the strategy which tells patients living in the Highlands and islands the services they can expect on their doorstep. It promises the six rural general hospitals will be staffed by surgeons, physicians and anaesthetists.

Just five years ago the future of consultant cover at these smaller medical centres looked precarious. Threats to withdraw consultants from the Belford Hospital in Fort William and Lorn and Islands Hospital in Oban were fought off, but only after widespread public protest.

The new action plan has been welcomed, although doctors warned significant work is still needed on the ground.

MSP Jamie Stone also wanted more detail about the future of maternity services, expressing concern the plan could see this downgraded.

As well as Fort William and Oban, the rural general hospitals are based in Caithness, Orkney, Shetland and the Western Isles. Together they serve 150,000 people.

The Scottish Government states the core services which hospitals will provide include routine and emergency surgery, initial management of broken bones, management of acute medical conditions and midwife-led maternity care.

In a letter to Ms Sturgeon, Mr Stone vowed to fight tooth and nail for consultant-run maternity services. He said: "Twice now the consultant-led maternity service based in Caithness General Hospital in Wick has been considered for downgrading to a midwife-led service. Twice the local people have strenuously opposed this backward step, and twice they have won the argument."

However, others were more optimistic about the strategy.

David Sedgwick, consultant surgeon at the Belford, said he was delighted the team work which had gone into securing recognition for rural healthcare had now been endorsed.

He said: "I am confident the future of rural general hospitals has been placed on a very secure foundation and has a definite direction of travel. This contrasts to the situation five years ago."

He stressed it was important to ensure Scotland's medical education deaneries and health boards helped to train surgeons, physicians and anaesthetists to work in rural areas. The trend for doctors to specialise in narrower medical fields has been one of the key threats to rural hospitals, where clinicians require a wider range of skills.

Dr Andrew Buist, of the British Medical Association's Scottish Council, said the new report offered some solutions to the difficulties of delivering rural medicine. He added: "There is much more to do to transform this report into reality and I hope we can work with the Scottish Government and NHS boards to implement many of its recommendations."

The action plan includes training a new type of GP with extra skills in emergency medicine, ensuring rural hospitals have modern technology including CT scanning and better ambulance links. A pilot where consultants are flown to remote hospitals to transfer critically ill patients is planned.

Launching the report in Aviemore, Ms Sturgeon said: "After years of uncertainty, this report sets out a blueprint which will secure vital services for our rural communities."

Services provided

Gilbert Bain Hospital, Lerwick, Shetland
Has 26 acute surgical beds and 20 acute medical beds and a midwife-led labour suite.

Balfour Hospital, Kirkwall, Orkney
Has ward for medical and surgical treatment plus GP-led maternity ward. Two consultant surgeons and two consultant anaesthetists provide services.

Western Isles Hospital, Stornoway Has 212 beds and offers general surgery, anaesthetics, orthopaedics and a consultant-run maternity unit.

Caithness General Hospital, Wick
Has 86 beds, including a general surgery and general medical ward and a consultant-led maternity service.

Belford Hospital, Fort William
Has 72 beds. It houses a general medical and general surgical ward and a small midwife-led maternity unit.

Lorn and the Islands Hospital, Oban
Offers general medicine and general surgery services, staffed by eight resident consultants, plus a midwife-run maternity unit.