Acute stroke specialist assessment and care requires the 24/7 availability of intravenous thrombolysis. Differences in geography and rurality demand differing models of care. Lancashire and Cumbria have implemented a telemedicine solution with a rotating virtual hub out of hours enabling 2-way audiovisual consultations. To minimise treatment delay the stroke physician interprets the acute stroke CT brain scan with recourse to radiology support if necessary. Formalised training and assessment in acute CT interpretation was provided for the participating stroke physicians. This involved a programme of training and assessment days and training material including a standardised CT reading template. Core elements of this material have now been included in the recently launched Ebrain project. In Lancashire and Cumbria, ongoing multidisciplinary meetings with neuroradiology support enabling review of treated cases should help to facilitate maintenance and development of skills in the interpretation of CT for acute stroke by stroke physicians.