February 2025 Edition

Welcome to this month's edition of Casebook, where we focus on pressing issues and innovative solutions in rural healthcare. We spotlight the funding crisis facing rural pharmacies and explore insights from the latest report by the Health Innovation Network, shaping the future of rural health services. This edition also features vital resources from The Patients Association, aimed at empowering patients to understand their rights and maximise their healthcare experiences. These tools are especially crucial for those facing unequal access to services and systemic discrimination, providing them with the knowledge to access necessary support and advocate for their health needs effectively. Additionally, read further insights from RABI, Rotherham Doncaster South Humber NHS and United Utilities, all promising to enrich our understanding and response to rural health challenges. Read on...

NPA Highlights Funding Crisis in Rural Pharmacies

The National Pharmacy Association (NPA) has recently brought to light a critical issue impacting rural communities across rural communities in England, particularly in the South West. Over the past decade, funding cuts have led to a significant reduction in pharmacy services, severely affecting access to essential healthcare in these areas.

According to the NPA, the last two years have been especially challenging, with more than 134,000 hours of service lost in the South West. This alarming decline in availability is part of a broader trend seen across England, where nearly 800 pharmacies have closed their doors permanently over the last four years. The association has identified a 40% reduction in funding as a primary cause of these closures and service reductions.

The impact of these cuts extends beyond mere statistics. In rural settings, where the nearest healthcare facility may be miles away, pharmacies play a pivotal role in the community health ecosystem. They are often the first point of contact for medical advice and treatment, making their accessibility crucial for preventive health care and the management of chronic conditions.

Deepening Rural Healthcare Crisis

In areas like Cornwall and Devon, local pharmacies have seen drastic cuts in operational hours. Cornwall alone has experienced a loss of 41,000 hours of pharmacy services, with Devon not far behind at 49,000 hours. These cuts force residents, particularly the elderly and those with limited mobility, to travel greater distances for basic health services, exacerbating their health challenges.

Pharmacists in these regions have voiced their concerns. Ian Bloxham, a pharmacist in Penryn, Cornwall, shared his struggles with the BBC, noting the increasing financial infeasibility of maintaining a pharmacy under the current funding model. "Each year, it becomes progressively worse to keep the business viable," Bloxham stated. He highlighted the discrepancy between the cost of providing medications and the fixed reimbursement rates from the government, which often results in significant financial losses.

Government Acknowledgement and Action

NPA, is advocating for immediate governmental intervention to reverse these troubling trends. A re-evaluation of funding strategies and increased support for rural pharmacies are essential to prevent further closures and ensure that rural communities have adequate access to healthcare services.

The Ministry of Health has acknowledged the issue, with Stephen Kinnock, Minister of State for Care, expressing commitment to addressing the challenges faced by community pharmacists. "We have inherited a sector suffering from years of underfunding and neglect, but we recognise the hard work pharmacists undertake daily to deliver for patients,". He committed to working closely with Community Pharmacy England to agree on a funding package that reflects the vital support pharmacies provide.

Insights from the Health Innovation Network's Latest Report

Health disparities have long cast a shadow over the well-being of rural communities, a situation further exacerbated by the Covid-19 pandemic. The recently published report by the Health Innovation Network, "Forging a More Equitable Healthy Future Through Policy and Partnership," offers fresh insights and actionable strategies aimed at addressing these enduring challenges.

The report encapsulates the findings and recommendations from a roundtable discussion convened in December 2024, involving senior clinicians, NHS leaders, policymakers, and community representatives. The primary focus was on leveraging innovation to tackle health inequalities—an issue of critical importance to both urban and rural populations alike.

Key takeaways include:

• The need for culturally competent approaches to healthcare.
• Utilising data-driven insights to tailor healthcare delivery to specific community needs.
• Strengthening community partnerships to ensure that health services are equitable and accessible to all.

Relevance to Rural Areas

While the report predominantly addresses general strategies for mitigating health disparities, several elements are particularly pertinent to rural settings:

• Place-Based Interventions: Emphasising tailored healthcare delivery, which aligns with the unique demographic and geographic challenges faced by rural communities.
• Community Partnerships: Highlighting the role of local collaborations, which are often the linchpin for effective healthcare delivery in less densely populated areas.

Case Studies of Interest

Among the practical initiatives discussed, certain projects reflect scenarios common in rural settings, such as:

• Community-Led Cardiovascular Screening: This initiative aimed to improve detection rates of atrial fibrillation and hypertension in communities typically underserved by mainstream health services. By deploying testing in accessible community settings, the project successfully improved trust and healthcare access among minority groups—a strategy equally applicable to rural populations often facing similar access issues.
• Co-Located Cancer Screening: Another initiative focused on increasing healthcare access and screening uptake for populations in deprived, rural, and coastal areas, using community hubs to integrate health services. This model could be directly translated to rural areas to enhance engagement and reduce logistical barriers to care.

Conclusions and Next Steps

The report stresses the importance of integrating innovative health solutions with a strong focus on equity to ensure that no community, is left behind. The insights and strategies outlined serve as a valuable resource for rural health policymakers, healthcare providers, and community leaders striving to bridge the gap in health equity.

For a full understanding of the innovative approaches and detailed case studies, read the full report HERE.

As we move forward, the Rural Services Network remains committed to advocating for and supporting the implementation of these recommendations within rural communities, ensuring that the vision of equitable health access and outcomes becomes a reality across all regions.

Shaping the rural health service

Health and Wellbeing Boards across England are currently preparing a document that shapes the delivery of NHS pharmaceutical services such as dispensing medicines. The new documents will be published in every HWB area by 1 October 2025. 

These documents, known as Pharmaceutical Needs Assessments (PNA), look at the demographics and health needs of the population both now and over the three-year lifetime of the document. They identify the current provision of NHS pharmaceutical services and identify any gaps now and in the future, which could include the need to open a new pharmacy.

PNAs include a large amount of information relevant to the area including the demography of its population (which will include visitors to its area), the different needs of the different localities, and how these factors will change during the three-year lifetime of the document, for example because of housing developments and regeneration projects.

As well as engaging with local service providers such as pharmacies and GPs, HWBs, as an NHS England organisation, will engage with the public to understand the services they access at pharmacies, how they travel to, and when they use pharmacies, as well as other influences on their choice of pharmacy. This information will help inform decisions as to whether there is a good geographical spread of pharmacies, that are open at the times required, and that are providing the services required to meet the population’s health needs – now and in the future.

In rural areas it is particularly important that the services of NHS dispensing GPs are noted as inappropriately documented gaps in the overall service provision could lead to a successful application to open a new pharmacy.

A pharmacy opening in a rural area will have an impact on any dispensing doctors providing services to that area.

The DDA would encourage all relevant parties including local people to ensure that these important documents consider the existing NHS GP dispensing service in their area.

For more information: About Dispensing Practice | Dispensing Doctors' Association

Knowing your rights and accessing support as a patient

Many patients are unaware of their rights and the additional support available to them as they navigate their healthcare journey. It is particularly important that patients who experience unequal access to services and systemic discrimination are aware of the financial and social support they can access.

The Patients Association’s new factsheet and animation were created to tackle this issue head-on, and empower patients to:

• understand their rights within the healthcare system, including the right to appropriate treatment, respect, and equal treatment, regardless of background,
• make the most of healthcare appointments, by preparing questions, discussing how their condition affects daily life, and ensuring that care is tailored to their needs and cultural background,
• access available support, including financial assistance through schemes like the Healthcare Travel Cost Scheme and NHS Low Income Scheme, as well as resources such as advocacy services, mental health support, and local charities.

These important and useful resources can be shared on social media, and used by both patients and healthcare professionals, particularly those supporting patients with cancer, blood disorders, or people from underserved communities.

• Download the factsheet
• Watch the animation

These resources were developed as part of the Patients Association’s project working with underserved communities living with cancer and/or blood disorders, however the resources are suitable for all patients. This project was funded by a grant from Bristol Myers Squibb.

If you’d like to know more or discuss how these resources might be useful to your organisation, please get in touch at [email protected]

RABI’s Recent Impact Report Highlights the Mental Health Benefits of Its Grant for Farming Families

In 2022, RABI introduced its Return to School (RTS) grant as a response to the impact of the cost-of-living crisis on the farming community. The grant aimed to alleviate some of the financial anxieties around back-to-school costs, such as uniforms, PE kits, equipment, and ongoing educational costs, so that recipients could focus more on their wellbeing. A recent social impact report published by the charity demonstrates the significant value of the grant, extending far beyond monetary support.

The report revealed that since the RTS campaign was launched, almost £3 million has been awarded to farming families, generating £6 million in social impact value and £9 million in total campaign value.

The positive social impact value was observed across the entire family unit, with parents sharing an improved sense of normality and inclusion due to the fact they were able to provide for their children in the same way as others in their community. In addition, the reduction in financial pressure led to a more harmonious home environment, which in turn improved family relationships.

Secondary school students, in particular, were found to have improved mental wellbeing following the grant, reporting that having new uniform and other essentials boosted their self-esteem and improved their sense of social belonging.

Support for young farmers

Secondary school can be a particularly vulnerable time for young people. RABI’s Big Farming Survey found that young farming people are the most likely to feel lonely, with 16% of farming people aged 16-24 reporting having no one to confide in. In addition to support for the whole family, such as RTS, RABI has a dedicated mental health support platform for young farmers aged 11 to 17 - Kooth.

Accessible on any device via bit.ly/RABI-clickandchat, Kooth includes information and guidance, a daily virtual journal for users to log their thoughts and feelings, and a mini activities hub to inspire other creative ways to explore emotions. There are also regular online forums and a messaging function to contact the counselling team for information and advice.

Content on the site is moderated, and age restrictions are in place to keep young people safe.

Engaging with the local community

Maintaining relationships beyond the immediate family circle is also known to be beneficial for improved mental wellbeing. RABI’s dedicated volunteers and County Committee members are constantly coming up with new and innovative ways to engage with the rural community across England and Wales, making opportunities to get off the farm and socialise.

We already have several great events planned for the upcoming months – make sure to keep an eye on our website, rabi.org.uk/events, for more information.

To read the full social impact report, visit bit.ly/RTSreport.

For access to any of RABI’s support services, visit rabi.org.uk or call 0800 188 444.

Rurality Services at Rotherham, Doncaster and South Humber NHS Foundation Trust

Rotherham, Doncaster and South Humber NHS Foundation Trust offers a number of health services including physical and mental health to people who live in a large and diverse geographical area. Whilst the central services of the organisation are based in Doncaster, given city status in 2022,  the locality of Doncaster also includes a rural population of over 14%.

Services delivered to families in Rotherham range from those based in the former industrial town to villages and rural locations. 9.5% of people in Rotherham live in a rural location.

Let us tell you about one of our places in more detail about its rurality: that’s North Lincolnshire. As of 2021, North Lincolnshire is the ninth least densely populated of Yorkshire and The Humber's 21 local authority areas, with around one person living on each football pitch-sized area of land. It is amongst the lowest 25% across England’s Local Authority areas for population density. In North Lincolnshire as a whole, areas have been classified into three groups depending on their population characteristics as follows:

• More than half (57%) of the resident population lives in ‘Urban city or town’, principally Scunthorpe but also part of Barton Upon Humber.
• Slightly over a quarter (28%) live in ‘Rural town or fringe’ such as Brigg, Burton Upon Slather or Epworth.
• One in seven (15%) live in a ‘Rural village and dispersed’ area.

In 2023 RDaSH, as we’re known informally, confirmed that we were committing to 28 Promises to the people who live and work in our communities, to the people who access our services and those of us that work in them. The intention of the promises is that the trust becomes a community partner and engages in collaborative and meaningful ways.

Promise 12   Work with community organisations and primary care teams to better recognise and respond to the specific needs of the rural communities and villages that we serve.

We chose this Promises consciously and deliberately: we know that rural communities can miss out on key health services due to issues such as transport and digital access. We also know that nurturing the power of communities and working with others will be key to sustained success.  

Our work on this promise started in North Lincolnshire where we’ve scoped out the public health data for the communities that we work in and as a starting point we are going to be using the mental health section of the Rural Communities Health Toolkit. We are planning to work with other organisations as well to work though the questions in the toolkit, see what we have in place and work to fill the gaps. A particular community and service will be our starting point in each of Rotherham, Doncaster and North Lincolnshire respectively. We'll then use the learning from the approach and findings in how we can apply to all our rural communities.    

We know this is the start and would be happy to learn from and share with others our journey as well as yours.

United Utilities partner with Sign Solutions to make communication easier for customers who use British Sign Language (BSL)

United Utilities have introduced a better way to engage with people using British Sign Language, as part of our Priority Services scheme

We’ve partnered with Sign Solutions to make communication easier for customers who use British Sign Language (BSL) as a primary language.

The ‘Interpreters Live!’ service, provides on-demand access to qualified, NRCPD registered, British Sign Language interpreters.

Customers can access Interpreters Live! via a link on our website and United Utilities will be listed in the Sign Solutions directory.

It means deaf customers using BSL can easily connect to an interpreter to make an onward call to our Priority Services team, who will then be able to facilitate the call as usual.

This is another example of our commitment to accessibility and a clear focus on:

• Making sure our services are accessible for everyone
• Providing different ways to contact us
• Providing dedicated teams to support Priority Services customers

Jemma Houghton, Priority Services manager said:

"Everything we do is about providing that extra help for those customers who need it most. Working together with trusted organisations like Sign Solutions really allows us to understand the customers we serve and provide them with the services that they need".

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Spread the word
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RURAL SERVICES NETWORK

Up to date news on Health and Care
The Rural Services Network provides a useful source of themed news content and data. Check out the latest news on Health & Wellbeing and Vulnerability, where you’ll find articles on a diverse range of rural issues affecting rural communities. You might also find this research on Over 65 Population Projections useful too.

Latest from RSN Member Insights
RSN Member Insights is the place to discover the statistics that define communities within our membership.  It is regularly updated with new analyses, and these will be highlighted in the 'What's New' section of the RSN's Weekly Rural Bulletin. The Rural Bulletin also provides a selection of the most rurally topical news items, so do subscribe and encourage your colleagues to subscribe to what is an invaluable weekly periodical.

The Rural Health & Care Alliance is a membership organisation administered by the Rural Services Network on behalf of the National Centre for Rural Health & Care.  Explore the RHCA service below: