Patients who need emergency surgery at nights or weekend are facing a 100-mile trip to Inverness because of a staffing crisis at a key Highland hospital.
Most of them will be transferred by road ambulance in a gruelling journey along the twisting A9.
People who need more urgent treatment may be taken to Raigmore Hospital by RAF or coastguard helicopter.
Caithness General in Wick will stop providing 24-hour surgical care to patients from next week.
It has been left operating with just one consultant surgeon after a retirement and the resignation of a senior member of staff.
Emergency measures have been put in place at the hospital, with consultants at NHS Highland’s flagship centre Raigmore having to offer support to patients in Wick.
Last night, the health board insisted the changes were not the start of a process of removing surgical services from Caithness altogether.
But worried local politicians called for a change in NHS structures to allow senior doctors to be shared between Caithness and Inverness.
Under the new system, from 6pm-8am on weekdays and all weekends, the on-call surgeon will be based at Raigmore and – although available for telephone advice and direct review of blood test results, X-rays and scans – will not attend Caithness in person.
Patients going to the Wick hospital will be assessed by a junior doctor and nursing team.
The revamp will take effect from Monday, December 15.
Dr John Macleod, consultant anaesthetist and clinical lead for the hospital, said: “Our ongoing problems with recruitment and reliance on locums won’t be a surprise to anyone.
“We have tried very hard to keep everything going but it’s now become so fragile that it’s not reasonable to continue as we are.
“We have therefore taken the decision that it is better to put in contingency arrangements on a planned basis rather than have to react to the next crisis.”
Dr Macleod added: “It’s a difficult time for all concerned because we realise that as well as managing our immediate difficulties we will have to agree a sustainable plan for the future.
“I am grateful to all clinical colleagues and managers for agreeing an immediate plan that allows us to retain both local emergency and elective surgical services.
“This is in no small part thanks to the Raigmore consultant surgeon colleagues for agreeing to provide back-up. Had this not been possible to agree then I fear we would have had to suspend the emergency service altogether.”
Dr Rod Harvey, interim medical director for NHS Highland held talks with local clinicians in Wick, and has been overseeing the contingency arrangements.
He said: “It’s clear that everyone wants to retain local surgical services but continuing with short-term locums is not the solution.
“This is definitely not the start of removing surgical services from Caithness but I do see it as a first step on the way to making changes for the future to ensure that local services remain of a high standard and are safe and sustainable.
SNP MSP Rob Gibson, who represents Caithness, Sutherland and Ross, said: “My sympathies go out to patients.
“I want to see training and recruitment for smaller Scottish hospitals built into the education system and the NHS board medical cover plans.
“Caithness folk want urgent reassurance that no downgrading of Caithness General Hospital will result from this cut in 24/7 services.
“I look forward to NHS Highland providing me with that reassurance. I will be discussing the issue with Health Secretary Shona Robison this week.”
Wick councillor Gail Ross said: “Obviously the priority at Caithness General is the patients and if this is the only solution at the moment then we have to work with it, although I can’t say I’m very happy with the situation.
“I do expect a review of patient transport in light of this development – if more people are travelling to Inverness then we have to make sure they can get there and our ambulance service is stretched as it is.”
Wick councillor Bill Fernie said: “It’s unfortunate, and not a situation that anybody wants.
“Obviously this is not as good as we would hope but I hope they keep the situation under review and if the situation improves then out of hour services can be restored.”