Abstract
Clinical teams from West Coast and Canterbury have jointly designed the Transalpine Health Service to provide safe, high-quality hospital care, as close to home as possible, for the rural West Coast community on New Zealand's South Island. Core acute 24/7 services at the small Grey Base Hospital are provided by West Coast Rural Hospital doctors with generalist skills across specialties, working with West Coast- and Christchurch-based specialists. Services to West Coast patients are provided in the most appropriate hospital in a ‘one service, two sites’ approach. An effective training structure and career path for rural generalism has been important. This includes undergraduate exposure to rural communities and the rural hospital medicine registrar training programme. Barriers and enablers to service redevelopment are described. The success of the Transalpine Health Service model has been built on the relationships developed between clinicians and strong organisational leadership for change.