BackgroundAccess to health services is often defined as choice of providers and ability to see a health professional within a certain timescale. However for people living in rural areas access to services can be defined more geographically in distance to services and time taken to travel to those services. Distance from services and lack of availability of both private and public transport can mean that some people living in rural areas may not make use of the health services that are available, and that they need to access. This is sometimes known as ‘distance decay’ where uptake of services, screening etc decreases with increasing geographical remoteness from the service.
New ways to access advice on healthcare via the internet and telephone helplines e.g. NHS Direct can be advantageous for people living in rural areas, however the reconfiguration of out of hours services may be problematic for some people who are unable to access Primary Care Centres and Walk In centres.
Accessibility planning in collaboration with other agencies is also an important part of planning and will be an ongoing process to ensure that the whole of the local population have good access to available services2.
SOME QUESTIONSQ1.Is there an effective working relationship with the transport planners at the County Council?
Q2.a) Are you involved in the development of the latest generation of Local Transport plans (LTP2)?
NB: info available at:
http://www.dft.gov.uk/stellent/groups/dft_localtrans/documents/divisionhomepage/032384.hcspb) Do you know the spread of current transport provision of :
a) Local commercial transport providers
b) Voluntary/community transport providers
c) Local Authority fleets
d) Patient transport services
c) Do you work in partnership with local ambulance services/acute service providers? Are all forms of transport provision embraced in the commissioning process for PTS from the local Ambulance Service NHS Trust?
Q3.In order to plan services what data is collected at?
a) Practice level
b) Ward level
c) Local Authority level
d) County level
Remember:Health inequality/deprivation is intrinsically linked. Pattern is different in rural as opposed to urban areas. Rural areas are heterogeneous so deprivation can remain unrecognised as the deprived and affluent members of a community live in close proximity to one another.
Q4.Is the data being collected and analysed at a level that will enable the PCO to:
a) Define how many of its patients live in rural communities and the proportion of practice populations designated as ‘rural’?
b) Systematically review geographical access to Community Hospitals, Out-of-hours Centres, Dental Access Centres, Minor Injuries Unit, GP Premises and larger Acute services sites?
Q5.Have you assessed the characteristics of the demand placed on services by
temporary residents i.e. migrant and/or seasonal workers, tourists, or travelling families?
Q6.Is there a plan in place to allow migrant workers, temporary residents, tourists etc easy access to health services?
Q7.Does the PCO work in partnership with local practices to develop facilities that are accessible to rural communities.
SOME SOLUTIONS 1. Develop effective partnerships with local transport planners, commercial operators, voluntary transport providers, other stakeholders e.g. parish councils re service need for access to health centres/acute services etc.
2. Begin dialogue with local populations, service users, and service providers to establish need.
3. Join rural transport partnerships to develop strategies to address access problems.
4. Look for non-NHS funding streams in partnership with other agencies.
5. Become involved in community transport initiatives in partnership with other organisations.
6. Develop and/or improve branch and outreach services in partnership with local practices.
7. Investigate practicalities of introducing mobile service provision.
GOOD PRACTICE EXAMPLESHolderness Area Rural Transport (H.A.R.T.)
The project became operational in September 2003 and is funded by a wide range of funding streams.
Aims and objectivesTo provide transport to healthcare facilities from rural, sparely populated communities in North and Mid Holderness in Yorkshire. To encourage more elderly people and people with mobility problems to travel and access key services.
This is achieved by operating the door to door, Dial-A-Ride, Community Transport MEDiBUS service, serving all the hospitals, doctors, dentists and specialist clinics in Hull and East Yorkshire.
Contact details:Co-ordinator and fundraiser: Caroline Wegrzyn
Tel: 01964 53 66 84
E-mail:
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Further details about these projects can be found on the database of good practice in rural health and well being at:
http://www.ruralhealthgoodpractice.org.uk1. Department for Environment, Food and Rural Affairs (2004) Rural Services Review, Defra Publications.
2. Health Inequalities Unit (2004) Accessibility Planning: An Introduction for the NHS. Department of Health.
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