20 Oct 2026
NHS funding and service reforms must better reflect the challenges facing rural and coastal communities, according to a new report from Policy Exchange.
For rural residents, getting healthcare can involve much more than securing an appointment. Long journeys, limited public transport and the cost of travelling can all affect whether people can access the support they need.
The Rural Penalty examines whether NHS funding, workforce policies and plans for neighbourhood health adequately reflect these challenges.
Its central message is that bringing care closer to home requires services to be designed around local geography, travel times and patient needs, alongside population numbers.
Making Local Care Accessible
The report supports the ambition to deliver more care locally through England’s NHS 10 Year Health Plan. However, it warns that organising services around large population groups could leave some rural patients travelling further if provision becomes concentrated in fewer locations.
It also argues that existing funding arrangements do not fully recognise the additional costs and workload facing rural general practice. Older populations, seasonal visitors and limited access to other services can create pressures that registered patient numbers alone do not capture.
Recruiting and retaining healthcare staff presents further challenges. The report highlights evidence that coastal communities have 15% fewer consultants per patient than the national average, despite serving older populations with greater health needs.
Recognising Hidden Rural Disadvantage
The report also examines how pockets of rural poverty can be hidden within wider averages, potentially affecting assessments of healthcare need and decisions about resources.
Among the sources referenced is the Rural Services Network’s Rural Lens Review: Indices of Deprivation 2025, cited in its discussion of the limitations of deprivation measures in rural areas.
The authors argue that assessments should better account for ageing populations, poor transport and the distances people must travel for care.
What Does The Report Recommend?
The report makes 15 recommendations, including:
- Better recognition of rural costs: strengthening rurality adjustments in GP funding and introducing additional weighting for primary care services funded outside the core payment.
- Support for essential small practices: helping surgeries remain viable where geography makes larger services impractical and closure would leave patients without reasonable access to care.
- A Local Access Test: assessing and publishing the implications for access before community hospitals or GP premises are closed.
- A stronger rural workforce: expanding training placements and addressing barriers such as housing, transport and employment opportunities for partners.
- Planning around real journeys: ensuring neighbourhood health services account for travel times and geography, alongside population size.
For rural communities, the report raises a practical question: will changes make care easier to reach?
Its findings reinforce the importance of recognising rural circumstances from the outset, so that the ambition to provide more care locally translates into accessible services.
