ABSTRACT
The principle of equal access to health services for those in equal need is one of the guiding tenets of the National Health Service (NHS) in the United Kingdom. Nevertheless, health services are inevitably located in particular places and are therefore more accessible to nearby residents than those living farther away. Variations in proximity are, obviously, only one element of accessibility to health services (Ricketts and Savitz, 1994), but the physical difficulties of overcoming distance tend to be particularly important in rural regions. Poor physical accessibility reduces the use of services and may lead to poorer health outcomes (Carr-Hill et al., 1997; Deaville, 2001; Jones and Bentham, 1997; Joseph and Phillips, 1984). Low utilization of primary healthcare services is of particular concern because of the gatekeeper role of general practitioners (GPs) in terms of referral to hospitals. Since the late 1990s, these issues of access have received renewed attention in the United Kingdom as part of broader debates regarding social exclusion and the future of rural areas (e.g., DETR, 2000a; Social Exclusion Unit, 2002). As a consequence, there have been substantial initiatives to improve aspects of public transport provision (Countryside Agency, 2002; DETR, 2000b), efforts to include an accessibility dimension in measures of multiple deprivation (DETR, 2001) and more thorough monitoring of changes in patterns of service availability (Countryside Agency, 2001a).
