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STPs are “variably” rural-proofed

GPs found to play a central role

February 12th 2019

Tagged: Rurality England

By Ailsa Colquhoun

A snapshot review of some rural STP documents indicates variability in the extent to which they consider rural evidence and the emphasis they place on accessibility for rural communities, a new report finds.

According to the State of Rural Services 2018 report, the second to be published by Rural England, greater emphasis on treatment away from a hospital setting and how this impacts on rural communities (positively or negatively) ought to be of considerable policy interest.

The report finds that GPs play a central role in health and wellbeing of rural communities. In terms of access to main hospitals, access is clearly more problematic for rural than for urban communities, especially for those who do not have access to a car.  The relatively older age profile in rural areas also indicates more and growing demand for hospital and/or other health care services.

GP surgery premises also act as a hub for the delivery of public health and wellbeing services such as advice. The report notes that delivering accessible and high quality services to rural communities can be challenging for service providers, given the scattered settlement pattern.  They may face lost economies of scale, high infrastructure costs, extra travel time and additional delivery costs.  Using different or innovative service delivery models is sometimes an answer.

Travel times to a GP surgery are said to be twice the national average: in rural areas it takes an average 9.3 minutes by car to reach the nearest GP surgery or 18.2 minutes by public transport or by walking.  This is almost twice as long as for urban residents.

The State of Rural Services reports are largely a response to concerns expressed about gaps in the evidence and, indeed, about a deteriorating evidence base.   For example, the report notes that while rural people generally enjoy better health than rural counterparts, young people from predominantly rural areas tend to score worse than (the England) average on public health indicators such as risky behaviour, alcohol consumption, smoking and being bullied.

That local authorities in rural areas receive significantly less funding for their public health responsibilities than equivalent authorities in urban areas, “begs the question whether this really reflects comparative needs”, the report says.

Several infrastructural challenges in rural areas are identified:

  • Local buses and community transport: half of households in small rural settlements had ‘reasonable access’ to an hourly or better bus service.  Some rural local authority areas (Cumbria, Isle of Wight, Oxfordshire and Wiltshire) have no budget set for subsidising bus routes.
  • Broadband and mobile connectivity: In 2018 11 per cent of rural premises could not get a 10 Mbps fixed line connection and 24 per cent could not get a 30 Mbps (superfast broadband) connection.  The equivalent urban figures are 1 per cent and 3 per cent respectively.  With mobile provision, in 2018 a basic phone call could not be made inside 33 per cent of rural premises on all four networks.  A 4G connection could not be accessed on all four networks inside 58 per cent of rural premises.  The equivalent urban figures are 3 per cent and 17 per cent respectively.

Key rural statistics included in the report:

  • Population resident in rural areas of England (2016): 9,370,200
  • Per cent of England’s population that is resident in rural areas: 17.0 per cent
  • Rate of population growth in rural England from 2011 to 2016: +2.6 per cent
  • Per cent of rural population that is aged 65 or over: 24.1 per cent
  • Number of registered businesses in rural England (2016/17): 547,000


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