Search the website

Healthcare in a rural setting

January 2005
Board of Science

Accessibility and the impact of distance
Access and transport are two major problems facing rural healthcare. In rural areas there are:
• additional travel costs associated with providing services
• additional travelling time for healthcare professionals and patients
• difficulties faced by individuals in gaining access to health services. [go to reference 10]

Access to services is a major difficulty for many rural residents, and there is evidence that some health outcomes for rural patients are poor compared with those from urban areas.[go to reference 9] In a study in Scotland, distance from services was found to be the most significant factor on the take-up of breast screening services, followed by lack of car ownership, full-time employment and being married. [go to reference 75] A delay in screening may lead to a delay in diagnosis and thus treatment. In rural East Anglia, asthma mortality was found to increase with travel time to hospital. [go to reference 76]

Increasingly, many services are being withdrawn from local areas and centralised in larger city centres. This means that many rural residents have to travel large distances to gain access to services such as A&E care that the local GP cannot provide. [go to reference 21] For example, one practice in remote Scotland has 5,000 patients who live an average of 130 miles away from the nearest district general hospital.[go to reference 38]

Another consequence of the centralisation of services is the lack of choice about facilities available to rural patients. Urban residents may be able to choose which GP to register with, but for most rural patients there is only one service available. [go to reference 21] The Countryside Agency’s recent report on services in rural England found that there is a steady decline in the number of doctors’ surgeries. In 1991, 16 per cent of rural parishes had a GP’s surgery, compared with 14 per cent in 2001. [go to reference 21] Withdrawal of services such as family planning clinics, and a lack of choice in regard to facilities and GPs, may prevent people from seeking out these services.

A survey on attitudes and opinions about access to healthcare in relation to location, focusing particularly on opinions about appropriate levels of access for those living in rural/remote areas of Scotland, can be found in a study by Farmer et al (2004). [go to reference 67]