It highlights some achievements, including the development of an education and performance management framework to ensure that services in remote community hospitals can be delivered, the establishment of the aerial medical emergency retrieval service, and the establishment of new specialist training programmes in remote and rural general surgery, anaesthesia and general medicine. It concludes that many of the targets that were set by the implementation group have been met, but highlights the work that still needs to be done.There is always work to be done, particularly when budgets are under considerable pressure.