An outreach service for a rural population which finds conventional health services inaccessible has made pleasing progress, reports Thelma Agnew

At last year's Rural Health Forum, the then health secretary, Frank Dobson, delighted his audience by declaring he wanted action not more studies and surveys from 'pointy-headed academics'.

This year, it seemed the pointyheaded academics had taken Mr Dobson at his word. The day's most striking presentation came from a Lancaster University team which, instead of simply collecting more data on sickness and death in the countryside, had developed a new service to improve the health of rural communities.

Action Research Farmers Health, a project co-ordinated by the university's Institute for Health Research, is an attempt to deliver healthcare to a group which finds conventional health services inaccessible, to say the least.

One of the project leaders, Dr Maggie Mort, said accident and emergency staff and GPs told her that farmers do not come to them 'unless their arm is hanging off '.

Farmers, said Dr Mort, are the 'new poor', and the risks to their mental and physical health are high and getting higher.

'A lot of old farmers are taking on the burden of dangerous jobs on the farm because they don't want their sons to be badly injured. You have 60 to 70year-olds out in all weathers doing really dangerous jobs because they want to protect the younger men.'

The NHS's willingness to leave this apparently 'stoical' group to their own devices had to change.

'If you can show there is a group out there whose health needs are not being met then you have a responsibility to do something about it, ' said Dr Mort.

'Very few farmers identify health professionals as a source of help - many call the vet rather than the GP.'

Vets' superior knowledge of zoonosis (the transmission of disease from animals to humans) means that the vet may actually be the farmers' best option.

'Often farmers get misdiagnosed by GPs. One farmer I know of sent his son to the GP because he thought he had leptospirosis, a fatal disease you catch from cattle. The GP said: 'It's just a virus, go home.'

With GP Dr Tim Burnett and a multidisciplinary project team, Dr Mort has created a specialist outreach service for farmers and their families in North Lancashire and South Cumbria.

Believed to be the first in the UK, the£190,000 scheme has been funded by North West regional office, the North West Development Agency and the European-funded Bowland Initiative.

The project hinges on two nurse practitioners, employed on behalf of the project by Bay Community trust in Morecambe, who have been trained to deliver healthcare where farmers live and work.

Since July the nurses, both from rural backgrounds, have been visiting farms, agricultural shows and auction marts, where their presence is often announced by the auctioneer. Young Farmers' groups and the Women's Institute are also being targeted.

The nurses are not there to hand out leaflets or 'educate' farmers into using conventional services. From a medically equipped van they carry out investigations and deliver care on the spot.

Farmers' long working hours and heavy responsibilities mean health serv ices have to go to them, argued Dr Mort. 'It's time to stop blaming the 'victims' of inadequate rural health services.'

In many respects the Action Research project is a shining example of the kind of quality accessible care New Labour has trumpeted. Dr Mort and her team now hope that the new health secretary will do his bit to help services on the ground turn health department rhetoric into reality.

The project's greatest wish - and the key, perhaps, for all rural communities where access to GPs and hospitals is limited - is greater prescribing freedom for nurse practitioners. The team plans to write to the health secretary asking him to remove the barriers to this.

Project member Professor Mike Walsh told the Forum: 'If Alan Milburn does nothing else, let him at least move this forward. Nurse practitioners are a new breed drawing on the best of both the medical and nursing traditions. They can be the first point of contact - it doesn't have to be the GP who is the gatekeeper.'

Most speakers at the forum presented the government's 'New NHS' as a long overdue opportunity to change services to match rural communities' needs. But optimism was streaked with an anxiety that the chance might be missed. After such long neglect, rural health services and their 'invisible' communities need to learn fast how to make demands.

Richard Taylor, chief executive of Lifespan trust in Cambridgeshire, said: 'A lot of us believe the rhetoric that's coming out of the government.

The Department of Health is saying many of the things that we have been saying for years. We need to capitalise on the rhetoric to support our case.'

Once the government has been persuaded to deliver on the details it will be up to local managers and professionals to make the new NHS work for the countryside.

This will not be easy. 'The key is to have a coherent vision of the whole process and stick with it, ' advised Mr Taylor, 'because it's hard work, working across boundaries. We have too many people with too much baggage wanting to stay as they are.'