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Nine in ten city residents can reach a hospital within an hour. In the countryside it is about half

Qurexa Editorial Team4 November 20269 min read 0 0
Nine in ten city residents can reach a hospital within an hour. In the countryside it is about half

What happened

On 4 November 2026, the Chief Medical Officer for England published his annual report. The Chief Medical Officer is Professor Chris Whitty. He is the government's most senior medical adviser. Each year he picks one subject and goes deep into it. This year's subject is health in rural areas and small towns. The report runs to 288 pages and has 13 chapters. It was published by the Department of Health and Social Care. Its main argument is simple. Most people in England live in cities. But most of England's land is countryside, made up of small towns and scattered villages. And the people who live there are not just city people spread more thinly. They are different in ways that change what the NHS needs to do. In his foreword, Professor Whitty wrote: "The lack of regular public transport is one of the key challenges of providing health and social care in rural areas." He also had a message for the people who run the NHS. He wrote that "we must avoid assuming that models of healthcare that work in cities can simply be translated to a rural or small town setting." He ended on a hopeful note: "Improving rural health is entirely possible and should be seen as a national investment in the future as well as the here and now."

Why this matters

If you live in Lincolnshire, or anywhere like it, this report is about you. The core problem it describes is age. People tend to move out of cities to small commuter towns when they start a family. Many move to the countryside when they retire. Meanwhile, young adults often leave rural areas for cities to study or find work. Over time, that reshapes who lives where. Using 2024 population estimates, the report says adults aged 65 and over make up around 28% of people in smaller rural areas. In urban areas outside London it is around 18%. In London it is around 12%. The trend is heading the same way. In 2022, most areas of England had between 8% and 14% of their population aged 75 or over. By 2047, many areas are projected to be between 14% and 25%, especially in coastal and rural places. Older populations need more healthcare. That is simply what happens as people age. The report also points to the "old-age support ratio" getting worse: the number of people of State Pension age keeps growing compared with the number of working-age adults who staff services and pay tax. So rural areas are heading towards more need and, at the same time, a smaller local workforce to meet it. The report says the NHS must plan for this now, rather than be surprised by it later.

What the evidence actually says

The most striking numbers in the report are about simply getting to a hospital. The report looked at how many people can reach health services within set journey times using public transport or walking. The figures are for 2019. For a GP surgery, the gap is real but modest. In urban areas, effectively everyone can reach a GP within 30 minutes. In rural areas it is around 80%. Stretch the time to 60 minutes and rural rises to around 95%. Hospitals are a different story. Around 90% of urban residents can reach a hospital within 60 minutes by public transport or walking. For rural residents, it is around half. It is worth being straight about these numbers. The report itself describes them with the word "around", because they are read off a chart rather than quoted to a decimal place. The broad picture is solid even if the exact figure is not. The second finding is about poverty, and it is less obvious. Rural areas often score as deprived on one specific measure, called "Barriers to Housing and Services". Many sit in the worst one or two deciles for it. But on the overall Index of Multiple Deprivation, most rural areas score in the better deciles, 7 to 10. The report's point is that this hides real hardship. Poorer households in the countryside get averaged in with wealthier neighbours. The report says the standard measures are "urban-optimised" and cover areas too large to pick up small pockets of rural poverty. So help may not reach people who need it, simply because the statistics do not show them. Third, farming. In Great Britain, agriculture, forestry and fishing had the highest rate of work-related fatal injuries of any industry: 8.09 deaths per 100,000 workers in 2025 to 2026, on provisional figures. The next highest was waste and recycling, at 5.47. The report also flags poor mental health in farming as an important and often hidden problem. Fourth, the workforce. Doctors tend to settle near where they trained. But in 2021, only around 25% of GP trainees had a placement in a small town or rural area. By 2026 that had risen to around 28%. Every region of England was below 50%. Finally, a note of caution the report makes about itself. Phone and video appointments are often presented as the answer to rural distance. The report is more careful. It says rural populations have some of the greatest opportunities to benefit from digital care, but also face the most significant challenges in accessing it. It states plainly that "telemedicine is not a panacea".

Qurexa perspective

We should be honest about where we fit in this. Qurexa is based in Lincolnshire, one of the most rural counties in England. We deliver prescriptions, help people keep on top of taking their medicines, and deliver groceries. So when a national report says transport and distance are the central barrier to rural healthcare, that matches what we see every week. But we should not overstate it. This report is not about pharmacy delivery, and it does not mention it. Having medicines brought to your door solves one part of the problem: the trip to collect a prescription. It does nothing about the harder problem the report identifies, which is getting to a hospital appointment an hour or more away. What is genuinely useful here is the report's framing. It treats rural access as a design problem to be solved, not as bad luck people in the countryside should simply accept. That applies to us too. If a delivery round, an appointment time or a reminder only works for someone with a car and a flexible job, it is not really working for rural customers.

Practical advice

None of this is your job to fix. But a few things in the report are worth acting on. Say it out loud if travel is a problem. The report specifically asks NHS services to be more flexible about appointment times for people who live a long way out, so appointments can line up with limited bus timetables. Services cannot do that if they do not know. When you book, say that you rely on public transport. Ask what community transport exists. The report notes that volunteer-run and formal schemes are already filling this gap in many rural areas, and says they should be supported. Your GP surgery, parish council or local council are the places to ask. Treat phone and video appointments as an option, not an obligation. They can save a long journey. But the report is clear you should still be able to get an in-person appointment if you need or prefer one. If you take regular medicines, get the repeat process set up properly. Repeat prescriptions, a nominated pharmacy and delivery all exist to stop a routine refill turning into a day-long trip. This is the one part of the problem that is relatively easy to solve. One small, specific tip. The report asks the public to do one thing: if you live in or have visited a rural area and have an infection serious enough to see a doctor, mention the rural visit. Infections caught from animals, ticks or insects are rare in England, and a doctor may not think of them unless you say. It costs you one sentence.

What to know

The Chief Medical Officer's 2026 annual report says rural and small-town England has a systematically older population, worse transport, hidden poverty and a fragile health workforce, and that the NHS needs to plan for this rather than assume city models will transfer. The headline figure is access. Around 90% of urban residents can reach a hospital within an hour by public transport or walking. For rural residents, it is around half. The report is not gloomy about it. Professor Whitty's own conclusion is that improving rural health is "entirely possible". But it asks for specific changes: flexible appointments, support for community transport, better measurement of rural poverty, digital care used sensibly, and far more rural training placements for GPs and nurses. Nothing in this report changes your care today. It is a set of recommendations, not a new rule. If something in it worries you about your own situation, your GP surgery or your pharmacist is the right place to raise it. Sources: Department of Health and Social Care, "Chief Medical Officer's annual report 2026: health in rural areas and small towns", 4 November 2026, https://www.gov.uk/government/publications/chief-medical-officers-annual-report-2026-health-in-rural-areas-and-small-towns ; Department of Health and Social Care, "Chief Medical Officer's annual report 2026: executive summary and recommendations (accessible version)", 4 November 2026, https://www.gov.uk/government/publications/chief-medical-officers-annual-report-2026-health-in-rural-areas-and-small-towns/executive-summary-and-recommendations-accessible-version ; Health and Safety Executive, "Work-related fatal injuries in Great Britain, 2026", cited in the report for the agricultural fatality rates, https://www.hse.gov.uk/statistics/fatals.htm This article is for general information and does not replace advice from a doctor, pharmacist or other qualified healthcare professional. If you are worried about your health or about getting to an appointment, speak to your GP surgery or pharmacist.

#rural health#Chief Medical Officer#NHS access#Lincolnshire#public transport#older people

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