10-year plan for England promises better rural-proofing

Rural differences can be reflected in the new neighbourhood services announced yesterday ahead of the publication of the full 10 Year Health Plan for England: fit for the future.

In the full document, DHSC pledges to design services “in a way that reflects the specific needs of local populations”. The document states: “We know… that ‘one size fits all’ misses the distinct needs of … people who live in more rural communities, among many others.”

Among the pledges are to introduce a modern form of earned autonomy for high performing local providers. There are also plans to move to a Single National Formulary (SNF) for medicines within the next two years coordinated by a new formulary oversight board, supported by NICE. Local prescribers will be encouraged to use products ranked highly in the SNF but will retain clinical autonomy if they prescribe in line with NICE guidance.

Commenting, DDA Chairman Dr Richard West warned that the Government needs to remove the barriers to innovation and provide the funding necessary to invest and improve on the ready-made rural neighbourhood health service which is already designed around patients.

He points out that dispensing practices already provide many of the services set out in the 10-year plan. They receive excellent ratings from the CQC. They are already designed around patients because they request that their practice dispenses medications for them.

In a 2024 report, Lord Darzi wrote: “...I also heard how the current GP standard contracts are complex and can mean that doing the right thing for patients can require doing the wrong thing for GP income. That cannot be right.”

The new 10-year plan fails to recognise the pressures facing rural dispensing practices:

The drug reimbursement system is unreformed, as it is the funding system for dispensing fees
IT is at the heart of the plan, yet after 20 years, an NHS funded electronic prescription service is unavailable to rural dispensing practices
Centralising vaccine purchase will reduce take up of vaccinations and exclude rural patients. Changing vaccination schedules confuse patients and put pressure on hospitals
Dispensary workforce recruitment and retention is inhibited by the lack of an inflationary rise in the value of the dispensing fee, which funds the costs of dispensaries.

Dr West said: “The plan is urban-centric and has not been rural proofed. Federating/vertical integration with metropolitan foundation trusts will not deliver any economies of scale. In fact, it would be more likely to see remote/rural practices closed, much as many community hospitals have been over the last decade. A lack of public transport makes it difficult for patients to move around.”

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