Data Insight: Assessing access to primary care in rural and urban Wales

This Data Insight, originally published by ADR Wales, investigates inequalities in rural primary healthcare accessibility using linked administrative data.

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Introduction

Following a presentation by Professor Ronan Lyons to a stakeholder group of Rural Health Care for Wales (RHCW) in 2023, there was an approach to assist RHCW in their ongoing research into health inequalities across rural areas of Wales, particularly the most sparsely populated Mid Wales region. A collaboration between ADR Wales researchers at Swansea University and RHCW was formed to conduct a pilot study on inequalities in rural primary healthcare accessibility.

The research questions related to distances travelled to GP surgeries in rural areas. Specifically, the questions posed were:

1. Do individuals use their nearest GP surgeries in rural areas? 
2. How far do people travel to attend their GP surgeries in rural areas?
3. How does this compare to distance travelled by patients to their GPs in more urban areas?

What we found

Are individuals registered to their nearest or a more distant GP surgery?

Within the study group, 63% of individuals were registered to their nearest GP practice, with the remaining 37% being registered to a more distant GP practice (see Figure 2 in full publication). This compares to 45% registered to the nearest GP in the comparison group.

Differences in distance to the nearest GP surgery were observed when study GP surgeries were grouped by rurality classifications, with 38.0%, 70.7% and 80.7% of individuals registered to their nearest GP in urban, village and town classifications respectively. Within the study group GP surgeries, the proportion of patients registered to their nearest GP surgery ranged from 24.2% to 95.4%.

How far do people travel to GP surgeries in rural areas?

There was wide variation across study GP surgeries, with a minimum mean distance of 3.1 km and maximum of 9.9 km. Table 2 in the full publication shows the mean distances (and standard deviation) and median distances travelled to registered GP surgeries for each study group, and for each rurality classification sub-division of the study group. The mean distance individuals travel to primary care GP surgeries across the entire study group was 6.3 km, compared with 2.3 km in the comparator group, a statistically significant difference of 4.1 km (p-value <0.05, confidence intervals 4.06-4.14 km). Median distances were shorter, with travel distances of 5.4 km and 1.8 km in the study and comparator groups respectively, a difference between groups of 2.6 km. For each of the additional rurality classification levels, all three comparisons (urban, town, village) were statistically significant, with distance differences of 2.5 km (p-value <0.05, CI 2.44-2.56 km), 4.5 km (p-value <0.05, CI 4.48-4.60 km) and 5.8 km (p-value <0.05, CI 5.69-2.84 km) respectively, compared to the overall comparator group.

Why it matters

Previous anecdotal evidence suggested that people do not necessarily register with their nearest GP, and that those in rural areas need to travel further to receive care. Previous methods to quantify these factors predominantly rely upon open-source data, often at area-level and are therefore limited in scope and accuracy. Further, previous methods without access to individual level data, such as that held in SAIL, can be limited to the assumption that individuals travel to their nearest GP surgery. Using the SAIL Databank and combining existing individual and household level data with specific road network distance data, we can overcome these challenges and provide new evidence. Such new evidence is important when taken in the context of the Welsh Government policy of moving care back to the community, with potential wider implications for those who live in more rural areas with further distances to travel to attend and receive care.

Our primary outcome findings add new empirical evidence to the previously unquantified theory that individuals do not necessarily register with their nearest GP surgery. Results show that overall, 63% of individuals within the study group register with their nearest GP surgery, compared to 45% in the urban comparator group. Furthermore, the level depends upon the rurality of the GP surgery location; around 81% of those in village areas and 71% of those in town areas register with their nearest GP surgery, whereas only 38% of those living in more urban areas register to the nearest GP surgery.

The findings also quantify differences in distances people need to travel to GP surgeries depending on where they live. We report the greater distances required to attend GP surgeries in Mid Wales compared to urban based comparator GP surgeries, with an overall difference of 4.1 km. We also provide further detail, showing generally the more rural, or more sparsely populated an area, the further the distance to travel, for example, those in areas classed as rural villages travel nearly 6km further than those individuals in the urban comparison group.

The combined factors of whether individuals register to their nearest GP surgery and the distance travelled act in combination and could suggest that people living in more rural areas have less choice over which GP surgery to attend. Understanding the reasons why people may choose not to register with the nearest GP are important to understand in a rural context where distances travelled are greater, for example the average distance to a GP surgery in rural village in a sparse setting is 8.0 km. Reasons that influence such choice are likely wide ranging and include reasons which include convenience of location (distance to home or place of work), historical relationships (potentially long-standing family doctor), health factors and the ability to secure appointments.