The challenges of delivering primary care networks in rural areas are highlighted in a new Rural Proofing for Health Toolkit.
Published by Rural England, the toolkit suggests dispensing practice services are among the solutions to rural healthcare planning challenges. Mooted solutions include:
- Mapping primary care services in the area (general practice, dentistry, pharmacies, etc) to understand their distribution in relation to rural populations and transport networks
- Delegating GP-led tasks to other trained healthcare professionals
- Prescriptions delivered to village shops for remote collection
- Encouraging take-up of virtual consultations.
The authors conclude that reforms such as Primary Care Networks have the potential to improve primary and community health care provision in rural areas, depending on how they are implemented.
Challenges include: sparsely populated geographies, expectations that specialist health professionals can serve such large areas and accessibility of health centres or health hubs. In addition, services have to reflect the (typically) older age profile found in rural areas, which may mean more patients with multiple morbidities.
A number of questions are posed by the report to facilitate rural service planning and design:
- What is the location of community pharmacies in the area and how adequately does that serve the dispensing needs of residents from rural settlements? Is there a role for dispensing surgeries to fill any particular gaps in provision?
- What effort has been made to ensure that funding priorities incorporate the needs of the area’s rural communities?
- Is there a case for Primary Care Network to drop below the expected 30,000 lower limit for patient numbers? Could operational concerns be monitored and addressed in other ways?
- What scope exists to expand the range of services delivered locally at medical centres, health hubs or community hospitals, to meet local needs and avoid patients travelling to main hospitals? For example, for minor procedures, diagnostics, oncology blood tests, in-patient rehab, baby clinics, re-enablement and end of life care.
- How easy is it for healthcare professionals to cover healthcare needs across the whole locality including any outlying areas?
- How will GP surgery alliances, mergers or relocations affect local access to surgeries and the services or clinics they host? If the proposals leave any local gaps in provision, how could these be addressed?
- What public transport options exist to help patients travel to GP surgeries, community hospitals and other health facilities, particularly in smaller rural settlements? Might community transport providers or schemes (such as volunteer car schemes) help to plug gaps?
- What are the travel costs and downtime for health visitors, district nurses, etc if they are regularly visiting patients with long term conditions in their own homes? Is any additional burden from such travel accounted for in resource and workload planning?
- What scope exists to offer and facilitate virtual consultations (by phone or online) for patients who may otherwise face difficult journeys to reach a traditional consultation? Similarly, could digital be used at surgeries or health centres to access advice from specialists based elsewhere (perhaps thereby obviating a hospital visit)?
- What collaboration or networking challenges arise, if any, for primary and community health professionals and managers where they are working across a geographically large rural area? Are there working practices which could alleviate these challenges?