Healthcare Access Challenges In Rural Communities: Identifying Barriers And Implementing Solutions

Healthcare access challenges are not unknown, with the NHS waiting list exceeding 7 million in 2023.¹ Additionally, people may experience a range of barriers to receiving care that include poor living conditions, uncertain immigration status, and poverty.² However, what is less spoken about are the additional challenges faced by communities living in rural areas, which, in 2023, amounted to roughly 9.7 million people in England.³ These areas are lacking in workforce planning and care services, which poses challenges for both staff development and access to care.⁴

The government has put in place strategies to address the three core difficulties specific to these communities (low funding, poor connectivity and workforce constraints). However, the success of these initiatives remains unknown.

This article explores these core healthcare access challenges that UK rural populations face, along with current – and potential – approaches to finding solutions.

Healthcare access challenges

Funding

One of the main contributing factors to healthcare challenges in rural areas is the unclear NHS funding distribution patterns. ‘Urban bias’ is seen as a common trend in healthcare services, as funding to larger medical institutions in urbanised areas is prioritised.⁴ However, strategies used to determine the funding allocations of different locations, such as Clinical Commissioning Groups (CCG’s), fund services in local areas accounting for the localised factors.⁵ 

Localised factors here refer to the local population’s specific needs and the funding requirements for these services. These usually account for additional costs, such as ambulance provision and limited capacity in smaller hospitals in remote areas.⁶

However, the effect of these is limited due to a larger problem eminent across policy in the UK: the tendency to stick to established practices rather than look to new approaches. This is important to consider, as funding allocations are usually kept the same to avoid negatively affecting the stability of health services in place.⁵ This can be seen in the case of hospitals in London, which, on average, charge clinical commissioning groups 29 per cent more than those in boroughs outside of London.⁵

Poor connectivity

Another key factor that needs to be considered is the deep digital divide between rural and urban areas in England.⁷ Outlined in surveys conducted by the Countryside Alliance, 46% of rural areas across England do not have access to 5G, compared to 2.7% in urban areas.⁷ This has huge implications for rural communities, such as limited ability to respond to health emergencies and contact emergency health services in a timely manner, and reduced access to medicines needing to be delivered. 

With the increasingly rapid speed at which NHS services are becoming digitalised, rural communities are being left behind and excluded from a range of healthcare services. This includes telehealth and access to patient information such as test results or ordering medications. Limited 5G Network could also impede the ability of hospitals to transfer patient information and discharge notes, potentially slowing down treatment in cases where this is required. 

Government plans are to double investment in digital health in the next three years, which could increase this divide significantly, reducing the healthcare services accessible to people in rural communities.⁷ With the average age of populations in rural areas being much higher than in urban, a lack of knowledge and experience in using these forms of technology now being integrated into healthcare provision further marginalises these communities.

As people of older age are more likely to have multiple health conditions needing investigation and treatment, this population is particularly at risk. Barriers to accessing healthcare services increase the potential for health complications or deterioration in people who may already be more vulnerable or frail.⁷ 

Workforce constraints in rural areas

With limited resources and opportunities for progression, rural hospitals and medical centres struggle to attract junior doctors and nurses who wish to specialise.⁸ A range of factors, which include extensive social and cultural opportunities and strong financial incentives, draw young clinicians to larger hospitals in urbanised areas. 

This results in a ripple effect on medical facilities in rural communities. Hospitals face recruitment difficulties and gaps in clinical positions, and rotas result in a reliance on temporary staff. ⁸ Consequently, this places a great deal of pressure on the full-time staff, which can lead to high employee turnover as staff struggle to work consistently long hours for longer periods of time. 

An additional factor to be considered, brought to light during the COVID-19 Pandemic, is the disruption to healthcare services arising from staff illness.⁸ With fewer staff and smaller teams, the repercussions on hospital wards are much greater, significantly affecting patient care.

Implementing solutions

Community health workers

 Community health workers play a vital role in delivering healthcare services in rural areas.⁹ As trained professionals, they can liaise between those providing and accessing healthcare facilities, helping with a range of services. These might include referrals for social services, tracking progress in individuals with chronic conditions, and conducting regular screening tests.⁹ Further adaption and implementation of the role of community health workers in rural areas could work to lessen the strain placed on overworked staff in smaller hospitals. Integrating their role into broader sectors of the healthcare system through partnerships with primary care practices could also improve services in rural communities.

Investment in healthcare infrastructure

Investing in healthcare infrastructure is essential for improving access to care in rural areas. This not only includes upgrading current healthcare facilities and medical equipment but, more importantly, investing in transportation infrastructure. This could contribute to improving connectivity issues.³

Strategies for workforce development and recruitment may include incentives such as: 

• Cancelling loans  
• Relocation assistance
• Providing training and professional development opportunities
• Implementing telecommuting options for healthcare professionals¹⁰

Collaborating with academic institutions to develop rural training programs and residency opportunities can also help attract and retain healthcare workers in rural areas.¹⁰

Current government strategies in place to address these challenges

1. Pharmacy Access Scheme

A £20 million initiative aimed at supporting rural pharmacies in England to remain open, ensuring accessible primary care. Approximately 46% of the 1,230 rural pharmacies qualify for support under this scheme. ³

2. NHS Community Pharmacist Consultation Service

Introduced by NHS England in October 2019, this service allows patients to schedule same-day appointments with community pharmacists for minor illnesses or urgent medication supply. It enhances access to services and offers convenient treatment closer to patients' homes. The service includes referrals from general practice, with potential for further expansion ³

3. Targeted Enhanced Recruitment Scheme

 This scheme provides a £20,000 salary supplement to incentivise trainee GPs to work in underserved areas, including rural communities. The government has been increasing the number of places on the scheme, aiming for 800 funded places in 2022. Trainees on the scheme often remain in rural areas after training, contributing to the sustainability of the GP workforce in these regions. ³

Summary

The article examines healthcare access challenges in rural communities, emphasising barriers like NHS funding distribution, digital connectivity, and workforce shortages. It highlights rural areas' struggles due to unclear funding and the digital divide, impacting emergency response and telehealth. Workforce constraints lead to recruitment difficulties and reliance on temporary staff, affecting patient care. Proposed solutions include leveraging community health workers and investing in healthcare infrastructure. Government strategies such as the Pharmacy Access Scheme, NHS Community Pharmacist Consultation Service, and Targeted Enhanced Recruitment Scheme aim to address these challenges. These initiatives aim to support rural pharmacies, provide same-day appointments with pharmacists, and incentivise GPs to work in underserved areas, contributing to the sustainability of rural healthcare.