ABSTRACT
A guiding principle of the National Health Service in the UK is the ideal of equal access to health services for those in equal need. Health services, however, are inevitably concentrated in certain places, and are consequently more accessible to nearby residents than people living further away. Inequality in accessibility due to distance is, of course, only one element of the problem of equal access to health services. Access to services can be represented as a continuum, across which many social, economic and cultural factors may contribute (Ricketts and Savitz, 1994), but the difficulty of overcoming distance tends to be a dominant factor in rural regions (Joseph and Bantock, 1982). Poor physical accessibility is known to reduce the use of services, and may lead to poorer health outcomes (Joseph and Phillips, 1984; Haynes, 1986; Jones and Bentham, 1997). Low utilization of primary care services is of particular concern because of the gateway role of general practitioners (GPs) in terms of referral to hospitals. There is a considerable body of research on variations in physical accessibility within rural areas of the UK (e.g. Moseley, 1977; Higgs and White, 2000), and the problem is still an important concern for several government agencies (Department of Environment, Transport and the Regions, 2000; Countryside Agency, 2001).
