A rural health symposium in Wellington has heard that major changes are occurring in the way health services are being planned and delivered.
Chris Mules, former chief planning officer at Counties Manukau District Health Board, told the conference that it is a time of generational change in health.
He said a growing and aging population, tight funding, urbanisation and worsening workforce pressures are part of this.
Mr Mules said small district hospitals are caught in a vice between more highly specialised services being provided elsewhere, coupled with the need to provide more services in the community.
He said rural communities face the first chance they have ever had to help design future sustainable services, including the ability of patients to consult a doctor and book a clinic online.