Policy Exchange says 116 constituencies face a ‘rural penalty’ under the Government’s decade-long health plan, warning that efforts to bring care closer to home could leave patients facing longer journeys and fewer local services.
Labour’s flagship NHS reform programme risks accelerating the disappearance of village GP surgeries across England, with rural communities potentially paying the price for a healthcare model designed around the realities of urban life, according to a new report backed by senior parliamentary figures from both sides of the political divide.
The warning from Policy Exchange, supported by former health secretary Sir Jeremy Hunt and health select committee chair Layla Moran, exposes a potential fault line in the Government’s ambition to transform the NHS over the next decade.
This is a strategy intended to bring treatment closer to patients could make access to care more difficult for those living furthest from major population centres.
The think tank estimates that 116 constituencies — roughly one in five English seats — are exposed to what it describes as a “rural penalty”, arguing that NHS funding and workforce policies fail to account adequately for the cost of delivering healthcare across sparsely populated areas.
At the centre of the dispute is the neighbourhood health model Wes Streeting unveiled last July. The plan envisages services organised around populations of about 50,000, with wider networks serving multiple neighbourhoods covering 250,000 people or more.
In cities, such population thresholds can be accommodated across relatively compact areas with established transport links. In rural England, the same number of patients may be scattered across dozens of villages, separated by long roads, limited public transport and significant distances between healthcare facilities.
The distinction is more than a question of administrative convenience. It could determine whether a patient sees a familiar GP in their village or must travel to a larger town for an appointment.
Joe Robertson, the Isle of Wight East MP and a co-author of the report, warned against the assumption that consolidating smaller services would automatically improve access.
“Closing three village surgeries and sending everyone to the nearest large town for treatment would be a curious way of bringing care closer to home,” he said.
The concern comes against a backdrop of sustained pressure on general practice. England has lost approximately 1,000 GP practices over the past eight years, according to the report, even as demand for appointments has increased. Rural populations grew by around 8 per cent between 2014 and 2024, yet local surgeries have continued to disappear.
Policy Exchange argues that conventional funding measures can conceal the true workload of rural practices. Smaller patient lists may make a surgery appear less busy, but doctors can face more complex consultations, greater travel demands and fewer nearby specialists to whom patients can be referred.
Existing funding arrangements also fail to reflect the full cost of geographical isolation, the report says. The rurality adjustment applies to only 50 to 60 per cent of practice income, leaving a substantial share of funding insufficiently weighted for the challenges of serving dispersed communities.
The result, the authors warn, is a system in which surgeries serving small populations can struggle to remain financially viable even when they provide an essential local service.
Their proposed remedy is an “unavoidably small practice adjustment”, designed to protect surgeries whose limited patient numbers reflect geography rather than inefficiency.
The report also calls for a compulsory “local access test” before any GP premises or community hospital can close, with the findings published so that the consequences for patients are transparent.
On staffing, it recommends reviewing NHS pay supplements, which offer financial incentives to some workers in and around London but provide no comparable allowance for rural locations. Recruitment and retention difficulties could otherwise deepen the disparities between well-connected urban centres and isolated communities.
The authors argue that these changes need not require additional overall NHS spending, proposing that any new rural funding weightings be financed from existing budgets.
For Ms Moran, the issue is one of fairness as well as efficiency.
“No one should face poorer access to healthcare or worse health outcomes simply because they live in a rural or coastal community,” she said.
Sir Jeremy emphasised the value of continuity in general practice, where familiarity with a patient’s medical history and personal circumstances can shape decisions about treatment.
“It is about knowing someone as a person, understanding their family, their circumstances, their wishes and what matters most to them,” he said.
Gareth Lyon, who leads Policy Exchange’s health and social care work, said the Government must account for populations that are dispersed, ageing and subject to seasonal fluctuations.
“Unless that changes, the 10-year health plan risks meaning fewer local services and longer journeys for large parts of England,” he said.
The Department of Health and Social Care defended its record, saying the Government was investing £14bn in GP services this year and had the highest number of fully qualified GPs in the workforce since 2015. It said 2,600 additional family doctors had been recruited over the past two years, with record numbers of appointments being delivered and 77 per cent of patients reporting a good local GP service.
“We know there is more to do to ensure that GP services in every area of the country are properly-staffed and providing a better service, including in rural areas, and we will continue working to address those challenges,” a spokesperson said.
The competing claims expose the challenge facing ministers as they reshape primary care. The Government’s ambition is to deliver more treatment within communities, but the report argues that a uniform model risks overlooking the geography that determines whether those services are genuinely accessible.
For rural patients, the test of reform will ultimately be straightforward: whether the NHS remains within reach of their homes, or whether bringing care closer to the community becomes a promise undermined by the closure of the very surgeries that make it possible.
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