Policy announcements by NHS England aim to improve patients’ access to NHS healthcare services. However, the following are just a few examples of how well-intentioned policy can have unforeseen side effects in rural areas.

1. Suggested changes to the GP partnership model: Replacing the GP partnership model with a fully salaried model risks undermining GPs’ ability to tailor care to the unique needs of rural areas and to deliver vital rural services such as NHS dispensing.
   
   
2. Primary Care Networks: NHS England funding policy for Primary Care Networks (PCNs) sets out a target that requires patients to be able to access a pharmacy, in order that they can use the General Practice Community Pharmacy Consultation Scheme (GPCPCS). However, by definition, patients who use a dispensing doctor do not have access to a pharmacy, and therefore cannot access the GPCPCS.
   
   
3. Medicine reclassifications: The UK medicines regulator recently announced easier access to a type of HRT without an NHS prescription. However, rural patients who cannot access a pharmacy cannot use this over the counter (OTC) supply route, as their local dispensing doctor practice is prohibited by regulations from selling OTC items.
   
   
4. Emergency access to medicines: During the pandemic the NHS refused to implement emergency regulations to allow all patients in rural areas to access medications from their surgery. This fails to reflect the emergency provisions that were enacted during the much less severe swine ’flu pandemic in 2009.
   
   
5. Changes to the GP Contract: GP contract changes, made because of the development of PCNs, allow local practices to work together to provide services to patients. However, no thought has been given to how rural dispensing patients can access medications if they are not seen by their own practice. This has meant that rural patients are, again, penalised because of a lack of planning by the NHS.
   
   
6. Mass vaccination centres: Currently, the NHS is trying to encourage large centres to undertake more vaccinations for the population. These may work well in urban areas where public transport is widely available, however, this fails to cater to the needs of patients in remote and rural communities.
   
   
7. GP+: In many communities, the GP+ service, offering an evening, weekend and Bank Holiday GP service is only based in urban locations. The use of this service by rural patients is very poor because many do not have access to public transport.
   
   
8. Static NHS funding: This year, the government has increased the minimum wage, and the employers’ National Insurance contributions. The dispensing fee, which is designed to pay for the staff to provide a dispensing service to patients, has not been similarly increased. To keep the dispensary operating as a going concern, GP practices have had to make savings elsewhere.

These are just a few examples of the unintended consequences that can arise from policies that are inadequately rural proofed.

The DDA is now inviting rural MPs to take the ‘rural challenge.’

NHS England is being permitted to discriminate against the nine million patients – a population which is larger than that of Greater London - who live in remote, rural, coastal and island communities.

NHS officials regularly talk about the urgent need to remove inequalities and inequities from the system, yet their policies suggest otherwise. 

We are asking MPs to:

• Please help your constituents to hold NHS England to account for its failure to deliver services to the whole population.
• Please use your voice in Parliament to challenge NHS England to deliver fully rural-proofed policy.

Together, we can give your residents access to the full range of NHS services, so that they get the health outcomes they deserve.