Healthcare in England’s villages and small towns needs to be planned around older populations, longer journeys and the realities of rural life, the country’s chief medical officer has said.
Professor Sir Chris Whitty published his annual report on 4 November, arguing that services designed for cities cannot simply be reproduced in more sparsely populated areas. He calls for national and local planning that recognises how transport, workforce shortages and hidden deprivation can affect access to care.
The report makes recommendations; it does not announce a new, dedicated rural funding allocation.
An ageing population and longer journeys
Whitty says rural and small-town populations are generally older and ageing more quickly than those in urban areas.
In 2024, an estimated 28 per cent of residents in smaller rural settings were aged 65 or over. Whitty stresses that illness and disability are not inevitable consequences of ageing, but that many conditions are more common among older adults. Services therefore need to account for the age profile of the communities they serve.
Distance is another challenge. Some patients have to travel a long way even for a GP appointment, while a hospital visit may take much longer. The difficulty can be particularly acute for people without a car, those unable to drive because of illness and those who cannot afford the cost of private transport.
For 2019, estimates suggest that around half of rural households could reach a hospital within an hour by public transport or on foot, compared with roughly nine in ten urban households. The figures describe access in that year and should not be treated as a measurement of today’s services.
Appointments, staff and local knowledge
Whitty recommends more flexible appointment times, allowing people travelling long distances to fit visits around available transport. He also points to the role of community transport schemes.
Whitty recommends remote consultations only when clinically appropriate and acceptable to the patient. They could help some patients avoid difficult journeys, but he says people who need or prefer an in-person appointment must still be able to obtain one.
Recruitment and training are another focus. Whitty says medical training is often organised around city practice and calls for more placements in rural and small-town settings.
Estimates suggest that around 28 per cent of GP trainees had a placement in a small town or rural setting in 2026, up from about 25 per cent in 2021.
Local knowledge also matters when measuring poverty. Whitty warns that deprivation in sparsely populated areas can be obscured when small pockets of need are averaged together with wealthier places. He calls for better measures and for local health teams to draw on community insight in the meantime.
Examples from rural communities
In Cumberland, public health director Colin Cox has argued that national funding arrangements do not fully reflect the extra cost of providing services across a large rural area. His assessment reflects a local concern; it is not a finding that every rural service faces the same shortfall.
During research for the report, Whitty visited the Severn Centre in Highley, Shropshire, where GP services sit alongside leisure facilities, family support and community groups. He also highlights the potential role of community hospitals in places where larger hospitals are difficult to reach.
Healthwatch North Yorkshire’s 2025 research, based on conversations with 220 members of the farming community, identified demanding work and travel distances as barriers to seeking care. Whitty suggests that more flexible appointments and outreach at agricultural events could help services reach farming communities.
The health department said it was working to improve access through neighbourhood health and community diagnostic centres and investing in GP services. Whitty calls for future decisions to reflect the different circumstances of people who live and work across rural England.
Featured image: AI-generated illustration.
