IT'S A typical idyllic rural setting - a village with a café, post office and local store amid spectacular scenery. But residents of this tranquil corner of Perthshire say they are missing a vital GP service which could put lives at risk.

In the past a doctor lived at the heart of the community in Kinloch Rannoch, attending to the needs of around 600 patients spread over an area of about 250 square miles. With the nearest large towns 20 miles away along winding country roads, being quickly on scene at emergencies any time of the day or night was a key aspect to the role.

Now out-of-hours care is provided by the health board via telephone helpline NHS 24, and locals claim the situation has led to lengthy waits for ambulances and residents being called upon during the night to help each other - and that it is deterring people, particularly the elderly, from living in the area.

The situation highlights the impact of the 2004 contract for GPs which allowed family doctors to opt out of providing round-the-clock care, enabling them to transfer the responsibility to health boards.

Now doctors' leaders have warned more remote areas could face recruitment problems over the next decade as the next generation of GPs may be even less willing to work out of hours.

The Kinloch Rannoch community was the first in the UK to ask an NHS appeals panel to rule against its GP being able to opt out, a bid which it lost in 2006.

When that GP retired earlier this year, residents hoped the replacement appointed by the health board would reinstate out-of-hours cover. Instead, the village surgery was taken over by a practice in Aberfeldy, which has also opted out of round-the-clock care.

Local resident Veronica Grosset, a former midwifery assistant, said she had been frequently called to assist an elderly neighbour who had difficulties using NHS 24. She claimed on one occasion it had taken six hours waiting for a doctor and then an ambulance to take him to hospital.

"NHS 24 has been great, the doctors have done their best for us and they have supported us," she said. "But it is the system that is totally wrong. My concern is if somebody has a heart attack here, there would be no way we can get medical aid in time out of hours."

Residents point out the country roads can make it difficult to get anywhere quickly, particularly in the depths of winter, and local knowledge enables locations to be found more easily.

Resident Randolph Murray said: "The service failure in Rannoch out of hours is liable to cost lives at any time. We have been badly let down over this."

The community wants its local GP service to be reinstated and has met with John Swinney, MSP for North Tayside, who said he would be raising the matter with the health board and ministers.

"The area is thinly populated but far-flung," he said. "What is important is that people have the confidence the necessary emergency medical services will be there should they require them."

Representatives for doctors, however, are quick to point out the benefits the new GP contract has provided. Before its introduction, more than a quarter of family doctors were said to be seriously considering a career break from general practice because of unsustainable workloads.

Dr Andrew Buist, deputy chairman of the BMA's Scottish GP committee, said: "The freedom to have what most people regard as a normal life, that has been very welcomed by the rural doctors that have been able to opt out.

"If you were to go back to what the doctor in Kinloch Rannoch was doing three years ago - being on call for 14 days at a time without a suitable break - I don't think you would get many suitable takers for that."

He warned that while around 70 practices have continued to provide out-of-hours services in remote areas, this may not be sustainable in the next 10 years, with a new generation of doctors who have had their hours limited through the European Working Time Directive. "I think we may find some difficulty recruiting to these very remote areas in the future," he added.

The final report of the Scottish government's remote and rural steering group, published earlier this month, said out-of-hours cover must be provided as locally as possible to remote and rural patients. But it also warned that changes to practices in a large number of remote areas will be required to maintain work/life balance for GPs.

A possible solution it proposes is having a team approach to out-of-hours work, such as involving first responders - local volunteers trained in emergency treatment - or nurses.

Meanwhile, health officials insist adequate medical cover in Kinloch Rannoch is still in place. Susan Ross of NHS Tayside said: "We are continuing to monitor the volume of attendances out of hours, which remain extremely low."

A spokeswoman for the Scottish government said: "There is no evidence that residents of Kinloch Rannoch are being provided with inadequate out of hours care."