Revealed: Long GP waits in rural areas three times worse than urban ones

23 Sep 2023

Embargoed until 22.30 Saturday 23 September

New research reveals four week waits for GPs three times higher in rural areas than urban ones
Lib Dems to adopt pre-manifesto with right to see a GP within a week at its heart
Ed Davey calls for strategy to close urban rural divide in access to GPs

The proportion of people waiting four weeks or more for a GP appointment is three times higher in rural parts of England than in London, stark new figures published by the Liberal Democrats have revealed.

It comes as Liberal Democrat Leader Ed Davey calls on the government to launch a new strategy to improve access to GPs in rural areas. The Liberal Democrats are also set to put their proposals to give everyone the right to see a GP within a week at the heart of their pre-manifesto being adopted today.

The House of Commons Library research, commissioned by the Liberal Democrats, shows that on average people in rural areas are facing significantly longer waits for GP appointments than those in urban ones.

One in five (20.6%) patients living in rural areas waited two weeks or more for a GP appointment between April and June of this year, compared to 16.9% of those in urban areas.

The divide for waits of four weeks or more for a GP appointment was even more stark. 6% of patients in rural areas faced waits of 28 days or more for a GP appointment, around a third higher than the 4.6% of those facing four-week waits in urban ones.

The figures also show a damning regional divide, with rural communities in the East Midlands and South West facing the worst GP waits in the country. 6.6% of patients in rural parts of the South West waited 28 days or more for a GP appointment, over three times higher than the 2.1% of patients in London.

The Liberal Democrats are calling on the government to bring in a new strategy to close the gap in access to primary healthcare between urban and rural areas. This would build on the party’s commitment to give all patients a right to see a GP within a week, or within 24 hours if in urgent need. This would be achieved by increasing the number of GPs by 8,000.

The right to see a GP within a week would be enshrined into the NHS constitution, putting a duty on both the health service and government to ensure it happens.

Liberal Democrat Leader Ed Davey said:

“Millions of people across the country are struggling to get a GP appointment when they need one, leaving them waiting in pain and distress. GPs should be the front door to the NHS, but that door has been slammed shut in people’s faces after years of Conservative broken promises and neglect.

“Far too many people are being left without the rapid care and treatment they need, piling more pressure onto our hospitals and other NHS services. Our rural communities are being particularly badly impacted by these painfully long GP waits, showing again how the Conservatives are taking them for granted.

“The Liberal Democrats will tackle this crisis by giving everyone the right to see a GP within a week, or 24 hours if it’s urgent. We will narrow the divide between rural and urban areas, ensuring everyone can see a GP when they need to and get the care they deserve.”

ENDS

Notes to Editor

Full data from the House of Commons Library is available here. Maps from the library visualising the data are also available on request.

Note from Library: This measure is not a direct indicator of waiting times for GP appointments. It measures the time between when the appointment was booked and when it took place. This might partly reflect patient preference as well as enforced waits. It also only measures appointments that were booked, so if an appointment was refused for being too far in the future, that wouldn’t be recorded here. The figures also do not show the number of people who tried to get to book an appointment and failed.

The Liberal Democrats are calling for a new right to see a GP within 7 days to be enshrined in the NHS Constitution, putting a duty on the Government and the NHS to ensure it happens. This would be achieved by increasing the number of GPs by 8,000, through boosting training places, improving retention and launching a campaign to encourage retired doctors and British trained doctors working abroad to return to practice in the NHS. Our approach would take account of appointments intentionally outside the target due for example to expressed patient preference or medical needs.
At the last election, the Conservative Party promised 6,000 more GPs – but the number of qualified GPs has actually fallen by more than 900 since then.

Full Commons Library research

You asked for analysis of GP appointments, looking at the difference between rural and urban areas in the percentage of appointments taking place more than 2 weeks/4 weeks after booking. You also asked for a map if possible.

In short, there does appear to be a slightly higher percentage over 2 weeks/4 weeks in rural areas than urban areas. This varies by region. But there may be confounding factors, so I think we must be a little careful in interpreting this. I’ve explained this further towards the end of the email.

All data below is based on analysis of NHS Digital’s Appointments in General Practice, June 2023 release, and in particular the files in the “Practice Level CSV” folder.

Practice rurality

Information is published on the small areas (“LSOAs”) that the patients of each practice are registered with. We can classify LSOAs using the rural/urban classification from the 2011 census. Based on this, we can work out what percentage of patients at each practice live in a rural or urban area, and analyse the difference between practices serving rural areas and those serving urban areas.

The tables below shows this analysis (all tables are also attached in Excel format). Practices are divided into categories based on the percentage of patients living in urban areas. Because the majority of the population lives in urban areas, there are far more practices in the “high urban” categories.

The data shows that, between April and June 2023, practices serving the most rural areas had 21.3% of appointments taking place more than 14 days after booking (compared with 17.6% in England as a whole), and 6.2% taking place more than 28 days after booking (compared with 4.8% in England as a whole).

Based on previous analysis we know that London is an outlier in this data in that it has lower percentages than other areas. So it’s important to make sure that the “rural vs urban” comparison here is not simply a “London vs elsewhere” comparison. To check this, the second table in the image below excludes London practices from the data. This reduces the effect (for example, “England without London” average is 18.6% over two weeks compared with 17.6% when London is included. But even without London, there is still a difference between rural and urban areas.

However, the largest gap is still between the “90-95%” group and the “over 95%” group – suggesting that the difference may be about differences between urban areas rather than about urban areas vs rural areas necessarily. I’ve explored this further later in the email.

To be clear, the analysis here (and below) is based on the areas that patients live in, and whether these are urban/rural – not the locations of the practices themselves.

Regions

Because not all areas are alike, it’s useful to divide this data by region. To simplify matters, the table below presents a summary “urban” and “rural” figure for each region. The methodology for producing this figure is explained further down the email.

The data shows that almost all regions have an urban-rural gap on the “over 14 days” measure, and the gap is over two percentage points in all regions except South West and Yorkshire & Humber. For the “over 28 days” measure, all regions except Yorkshire & Humber have an urban-rural gap, and the gap is 1 percentage point or higher in three regions.

London is excluded from the urban/rural columns since well over 99.5% of the region’s population lives in urban areas.

Cities, towns and villages

I mentioned above that the practice rurality table suggested that there might be differences between different types of urban areas. We can analyse this using the Library’s City and Town Classification, which is an alternative to rural/urban analysis. This divides areas into “core cities” (like Manchester, Bristol, Newcastle), Other Cities, and Large/Medium/Small Towns. The “village or smaller” category captures all areas with a population below 7,500 and would include most rural areas.

The data shows that cities had a smaller percentage of GP appointments taking place 2/4 weeks after booking than towns, and that larger towns performed better than smaller towns. However, the gap between London and other core cities is larger than the gap between other core cities and villages/rural areas.