A flying doctor service for Orkney could be introduced by the local health authority in an attempt to save money.
NHS Orkney's proposals, which include basing a nurse in some of the smaller islands, could see the end of some resident island doctors.
The plans have provoked anger in Orkney's outlying communities.
Island doctors believe patients will be left in the hands of people who are not fully trained, but NHS Orkney said it had a duty to use its budget sensibly.
Orkney is one of the few areas of Scotland where GPs still carry out their own out-of-hours service.
Eight islands have a resident doctor working 35 weeks a year and for the remaining weeks cover is provided by locum doctors.
NHS Orkney said it could no longer afford to pay the £1m it cost to bring in locum doctors.
Paddy Johnston, knows as Patty, owes his life to the resident doctor on Hoy, after he suffered a suspected heart attack nine years ago.
"I used to work on the local ferry and on the way home I got a crushing pain in my chest and I started to sweat pretty badly," Mr Johnston said.
"My wife managed to get me down to the surgery, where I saw the local doctor and was diagnosed that I was in the throes of a heart attack.
"If it hadn't have been for the local doctor there's a good possibility I might not have been here today."
Mr Johnston said the introduction of a flying doctor service would cause "uproar" among residents and there was concern that bad weather could hamper urgent medical care.
Doctor Paul Kettle, at the Hoy and Walls Health Centre, said any alternative to having a resident doctor on the island would not provide sufficient healthcare.
"If a doctor is visiting from, say, Orkney mainland across the water, then it's going to be extremely weather-sensitive and we can be stranded for maybe two days at a time sometimes or occasionally even more.
"This is going to put people living on the island at considerable risk."
However, NHS Orkney defended its position and said the Scottish Executive was forcing it to balance its budget.
Chief executive Steve Conway said: "We're looking at finding savings of about £3m and the expenditure on the provision of doctors for the islands and the mainland exceeds our allocation by about £750,000 every year.
"So we've got to rationalise the provision."
Locum GP Wasyl Nimenko said it would be better if the islands were served by a flying doctor service.
He said: "The reality is you've got eight islands with about 2,660 patients served by eight doctors, whereas in the rest of the UK that number of patients would be served by one doctor."
Dr Nimenko said island residents should give up the idea of having their own doctor and he said doctors in that situation, with so few patients, were in danger of becoming de-skilled.
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Published: 2005/12/20 09:34:31 GMT
