The truth behind rurality: An increasing risk to individuals without access to a tertiary centre. Unethical rationing prevails.

The increased air pollution in the cities is countered by the lack of access to GP and specialist services in rural areas. The truth behind rurality is an increasing risk to individuals without access to a tertiary centre, Trusts have restricted choice.and this is particularly true in Wales where trusts such as Hywel Dda have restricted choice. Rationing by reducing choice options for certain post codes, but not for others, who pay the same tax, is unethical.

Image result for no choice cartoon

May Bulman in the Independent reports 18th March 2017: Beautiful Countryside hides the ugly truth…

The BMA news reports in Rural Health on 25th March 2017: Truth is hidden behind “picture postcard” image.

Poor health in rural areas is masked by “idyllic image” of the English Countryside, said local government and public health leaders in a joint report. Official statistics do not paint an accurate picture of people’s health outside cities., they warned. The report said that a sixth of areas with the worst health and deprivation in England are in rural areas; residents of rural areas are more likely to be over 65 than those in urban areas (23.5 v 16.3%); and rural residents are less likely to live within 4km of a GP surgery (80 v 98%) and 8km of a hospital (55 v 97%).

Have targets improved performance in the English NHS? | The BMJ – not in rural areas.

David Oliver reports in the BMJ: David Oliver: Challenges for rural hospitals—the same but different (BMJ 2017;357:j1731

The UK is densely populated. Even Scotland, with only 62 people per square kilometre, pales in sparseness next to Canada or Australia, whose densities are 3.2 and 2.6, respectively.1

Even so, our rural areas face distinct challenges, and the problems facing urban health systems are exacerbated in the countryside: less car ownership, worse public transport, longer travel times to GP surgeries. Practices are smaller and have more difficulty attracting GPs. The hospital is often a long round trip from patients’ homes. Distance makes access to moderate level urgent and ambulatory care crucial, as is rehabilitation or end of life care at or close to home, as well as family and social networks.23

Community hospitals, where they exist, can be used as a hub. GPs, paramedics, allied professionals, and nurse practitioners with enhanced skills and roles are invaluable.4

Rural areas aren’t homogeneous. Alongside bucolic idylls, much rural deprivation exists: social isolation, single occupier households, and unfit housing stock are more prevalent. Rural and coastal communities have a high proportion of older residents, compounded by “urban drift” in younger people.

It’s harder to attract a workforce to low paid caring jobs. Community practitioners and teams take longer travelling to and between patients’ homes. Funding formulas don’t reflect these additional costs, further disadvantaging rural areas.

And reconfiguration of health services based on urban models risks leaving whole regions without a hospital. Some specialised services clearly benefit from centralisation, but a smaller rural hospital should be able to do a great deal, including level 2 urgent care. In sparsely populated countries such as Australia, hospitals much smaller than the UK’s can provide a wide range of services.5

The lower patient volume and smaller peer group can make posts less attractive to subspecialists who want to maintain specialty interest and skills. Parallel rotas for acute, internal, and geriatric medicine, for example, may be unviable.6

There’s a pressing need for confident expert generalists happy to deal with most of what comes their way and for peripatetic hospital clinicians providing clinical support beyond the hospital’s walls. It’s especially hard to attract consultants to these roles, so substantive posts and rotas go unfilled.

Doctors tend to settle in the region where they complete specialist training, often with a family base in the town.7 Medical school places are disproportionately concentrated in big cities, limiting trainees’ exposure to rural medicine.89 Doctor-patient ratios and applications for training posts are higher in the metropolis.

If we want to ensure fair access to care in rural populations, tailored to their unique circumstances, we need plans to tackle these issues. And we have to start by recognising that their needs are the same but different.

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Is choice an illusion in Wales? Not if patients pay to go privately.

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This entry was posted in A Personal View, Commissioning, Post Code Lottery, Professionals, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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