Geographical narcissism. Urbansplaining. These are terms for when people in cities tell people in rural areas what is good for them – and we need to stop doing that.

Those were the words of BMA Scotland chair Dr Iain Kennedy speaking to the Health, Social Care and Sport Committee in December during its inquiry into healthcare in remote and rural areas.

For dispensing GP practices, who generally operate in rural areas, there are widespread examples of urbansplaining in health policy:

• Multidisciplinary teams (MDT): in rural areas challenges include inadequate funding for the excess costs of staffing, inadequate infrastructure to support the MDT, as well as problems with retention due to a lack of housing, schooling and job opportunities for partners
• Pharmacy First services: insufficient pharmacists and business viability challenges in rural areas
• Electronic Prescription Service (EPS): insufficient rural-proofing of programme specification and roll-out

New pharmacy services and IT developments such as the EPS offer important advantages to patient convenience and safety, and business efficiencies for the NHS and the healthcare professional.  

However, thanks to geographical narcissism, no thought has been given to how the existing rural network of providers of pharmaceutical services (dispensing GPs) might be supported to step in to fill the inevitable void in rural areas to be left by the development of pharmacy services.

Efforts to improve the stability of the pharmacy network, and increase GP capacity, for example, the current consultation on pharmacy supervision - GOV.UK (www.gov.uk), will count for very little in areas where there are no pharmacists. Ditto the roll-out of Pharmacy First services. When thinking about alleviating the financial pressures facing pharmacies, did any politician stop to wonder how dispensing GPs who share the same financial pressures – but who are excluded from delivering Pharmacy First – might be able to reassure their rural patients of their future financial stability?

Almost two decades ago, NHS England made the mistake of excluding dispensing GPs from the EPS. Now Scotland and Wales look set to repeat the error, exacerbating rural inequalities.

Rural areas have unique challenges and these need unique solutions.  It’s high time the urbansplaining stopped and proper rural-proofing started.