Village GP surgeries could be shut under Labour's NHS reforms as cities prioritised

A new Policy Exchange report, supported by former health secretary Sir Jeremy Hunt and health select committee chair Layla Moran, has warned that Labour’s decade-long NHS reform plan could force the closure of GP surgeries in villages across England.

The think tank argues that the Government’s neighbourhood health model, unveiled by Wes Streeting last July, was built with urban populations in mind and fails to account for the realities of delivering care in the countryside.

According to the study, 116 constituencies — roughly a fifth of all seats in England — are exposed to what the authors describe as a “rural penalty,” stemming from NHS funding and workforce policies that do not adequately address the difficulties of reaching dispersed communities.

The NHS plan aims to structure neighbourhood services around populations of 50,000, a threshold that policy experts say works in densely populated towns and cities but threatens to undermine healthcare access in rural areas. A broader framework envisions providers serving multiple neighbourhoods with combined populations of 250,000 or more.

In cities, tens of thousands of residents may live just a few miles apart, well connected by public transport. In the countryside, however, reaching the same number of patients can require covering vast stretches of land with few transport options.

Joe Robertson, the Isle of Wight East MP and a co-author of the report, cautioned against consolidating services. “Closing three village surgeries and sending everyone to the nearest large town for treatment would be a curious way of bringing care closer to home,” he said.

England has lost approximately 1,000 GP practices over the past eight years, even as patient demand has continued to rise. Rural areas have been particularly affected: the countryside population expanded by around 8 per cent between 2014 and 2024, yet surgeries in those communities have continued to disappear.

The report highlights that current NHS funding formulas do not properly account for the elevated costs of serving geographically spread-out populations. Practices with smaller patient lists may appear less busy, but the authors note these figures can mask more frequent and complex consultations.

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Rural GPs also shoulder additional burdens created by local shortages of pharmacists, dentists and specialists. The existing funding formula’s rurality adjustment applies to just 50 to 60 per cent of practice income, leaving a significant portion of revenue unweighted for rural factors.

Policy Exchange proposes an “unavoidably small practice adjustment” designed to safeguard surgeries where geographical isolation prevents economies of scale and where closure would cut off patient access.

The think tank also recommends introducing a compulsory “local access test” before any GP premises or community hospital can be shut, with the results made public.

Any additional funding weightings for rural primary care should be drawn from existing NHS budgets rather than requiring fresh spending, the report argues.

It further urges a review of NHS pay supplements, which currently offer financial incentives to staff working in and around London but provide no comparable allowance for rural areas. This imbalance, the authors warn, makes recruiting and retaining doctors and other healthcare professionals in the countryside significantly harder.

Layla Moran stressed that where someone lives should not determine the quality of care they receive. “No one should face poorer access to healthcare or worse health outcomes simply because they live in a rural or coastal community,” she said.

Sir Jeremy Hunt emphasised the value of enduring doctor-patient bonds. “It is about knowing someone as a person, understanding their family, their circumstances, their wishes and what matters most to them,” he said.

Gareth Lyon, who leads Policy Exchange’s health and social care work, said the Government’s ambition to move treatment into communities must take account of populations that are dispersed, ageing and subject to seasonal fluctuation. “Unless that changes, the 10-year health plan risks meaning fewer local services and longer journeys for large parts of England,” he said.

A Department of Health and Social Care spokesperson said: “This Government is putting a record £14billion into GP services this year, and we now have the highest number of fully qualified GPs in the workforce since 2015, with 2,600 extra family doctors recruited over the last two years.

“As a result of that progress, record numbers of GP appointments are now being delivered, and 77 per cent of patients now say they have a good local GP service.”

“We know there is more to do to ensure that GP services in every area of the country are properly-staffed and providing a better service, including in rural areas, and we will continue working to address those challenges.”