SUCH are the difficulties with both the pharmacy and optometry services at the Isles of Scilly Health Centre that councillors are threatening to bring in the Secretary of State.
The pharmacy concerns centre on what happens to any "out of hours" provision when the service – just one person – is shut as the GPs may not dispense medicines.
And the long delay in the implementation of an island-based optometry service, which was due to have started last summer, is continuing.
Strong condemnation came from a Health Scrutiny Committee meeting, with Christine Savill leading the way by saying "it was time we used our teeth".
She said they should "hold to account" the powers-that-be and called for a more forceful attitude and a direct approach to the Secretary of State over the deficiencies "not just for our community but in support of our GP services".
Scilly's senior GP, Dr John Garman, said the problems lay with NHS England, which was responsible for contractual matters.
He said a potential solution to the pharmacy impasse, in what he called "special circumstances", could be for them to take out a wholesalers' licence "and effectively wholesale to ourselves".
The modest amount of any island-based optometry service worked against viability, he said, but hoped it would be in place "fairly soon".
Jane Hurd, of patients' watchdog Healthwatch, thought a "who pays what" bureaucracy was the stumbling block. She said they were coming up against "a brick wall".
Dr Garman asked that they should hold off approaching the Secretary of State until a reply had been received from the Local Area team, although the latter were pilloried for being too distant from the islands' needs.