A fifth of England faces a ‘rural penalty’ that threatens to deprive residents of doctors and crucial NHS funding, a damning report warns.
Millions of patients in rural and coastal areas stand to lose out under Labour’s plans to shift more care from hospitals in to the community, it adds.
The Policy Exchange think tank accuses the government of designing one of the core aims of its 10 Year Health Plan around the needs of major towns and cities, such as the Prime Minister’s beloved Manchester.
These typically have multiple health facilities and well-functioning public transport systems that allow patients to travel easily between sites.
But the report warns 116 constituencies across England are ‘far removed from this’ and that funding formulas and workforce policy included in the plan around neighbourhood health ‘have all neglected this reality’.
This risks creating an ‘increasing divide’ between rural and urban areas, as the plan fails to recognise the higher costs of caring for older, more isolated populations.
The new model of care is organised around populations of 50,000 or more, raising fears that smaller local services could be consolidated into larger health hubs.
However, researchers say this could backfire in rural communities, forcing patients to travel further for appointments as smaller GP practices disappear and the ‘brain drain’ from hospitals accelerates.
Millions of patients in rural and coastal areas stand to lose out under Labour’s plans to shift more care from hospitals in to the community, the report warns
The report, titled The Rural Penalty, notes: ‘Closing three village surgeries and sending everyone to a centre in town would be a curious way of bringing care closer to home.’
It highlights figures showing that coastal communities have 15 per cent fewer medical consultants, 14.6 per cent fewer postgraduate medical trainees and 7.4 per cent fewer nurses per patient than the national average, despite having older and less healthy populations.
And it warns funding formulas, NHS pay deals and workforce policies are reinforcing geographical inequalities instead of tackling them.
NHS staff working in inner London can receive salary top-ups of up to 20 per cent but those outside the capital receive no equivalent geographical allowance.
Meanwhile, only around 50 to 60 per cent of GP practice income is covered by the Carr-Hill formula, which includes an adjustment for rurality.
Other income fails to consistently recognise the additional expense of delivering care across sparsely populated areas.
The report said that the ambition to move care into the community ‘is welcome in theory’, but for it to succeed, ‘rural and coastal areas need to be able to compete on a level playing field in recruitment and retention and need to be funded according to their local conditions’.
It added: ‘If this does not happen then for all the 10-Year Health Plan’s commitments to localism, the reality for many patients will be reduced local services, longer journey times and an increased divide between better resourced areas in cities and under-provisioned rural and coastal areas.’
Report author Gareth Lyon, head of health and social care at Policy Exchange, warned patients in rural areas may face longer journeys for care
The report’s authors call for an ‘unavoidably small practice adjustment’ to protect rural GP surgeries that cannot realistically merge or achieve economies of scale without leaving communities cut off.
They also call for changes to NHS pay arrangements, stronger protections against local service closures and a dedicated minister responsible for rural and coastal healthcare.
Report author Gareth Lyon, head of health and social care at Policy Exchange, said: ‘The Government has the right ambition to want to move more care out of hospitals and into communities but that shift needs to recognise the different needs and cost of serving dispersed, older and seasonally fluctuating populations.
‘Pay structures which incentivise working in London over remote and coastal areas also makes it harder for rural providers to recruit and retain staff.
‘Unless that changes, the 10-Year Health Plan risks meaning fewer local services and longer journeys for large parts of England.
‘Ending the rural penalty is essential to the plan’s success.’
The Policy Exchange report has been backed by former health secretary Sir Jeremy Hunt and Layla Moran, chairwoman of the Commons Health and Social Care Committee.
Ms Moran said: ‘No one should face poorer access to healthcare or worse health outcomes simply because they live in a rural or coastal community.
Liberal Democrat MP Layla Moran, chairwoman of the Commons Health and Social Care Committee
‘Everyone deserves a fair chance of a healthy life, wherever they call home.
‘Recognising the different circumstances of these communities is not special treatment.
‘It is how we make fairness a reality in the care people receive and the lives they are able to lead.’
Sir Jeremy said: ‘Having seen the difference continuity of care can make over many years, I know that general practice is about far more than treating an illness.
‘It is about knowing someone as a person, understanding their family, their circumstances, their wishes, and what matters most to them.’
Tory MP Joe Robertson, who represents Isle of Wight East, a member of the Commons Health and Social Care Committee and co-author of the report, said: ‘Health policy is too often designed as though every patient lives in a city, within easy reach of several hospitals and a choice of GP surgeries.
‘For my constituents on the Isle of Wight, and for many other parts of the country that is not true.
‘Closing three village surgeries and sending everyone to the nearest large town for treatment would be a curious way of bringing care closer to home.
‘If neighbourhood health is to mean anything in rural and coastal England, care has to be local by default, and NHS funding and pay structures need to reflect this.’
A Department of Health and Social Care spokesperson said: ‘We know there is more to do to ensure that GP services in every area of the country are properly staffed and providing a better service, including in rural areas, and we will continue working to address those challenges.’
