The effects of accessibility on general practitioner consultations, out-patient attendances and in-patient admissions in Norfolk, England

A social survey was conducted to investigate the effects of accessibility on contacts with general practitioners and hospitals under the National Health Service in the predominantly rural county of Norfolk. Random samples of adults were taken close to hospital and general practitioner services in the city of Norwich, in villages close to Norwich with and without a general practitioner surgery and in villages relatively remote from the city with and without a surgery. General practitioner consultation rates, out-patient attendance rates and in-patient admissions were all found to decline with decreasing accessibility. For people with a long-standing illness, the main difference in rates was between urban and rural areas. The groups most affected in the rural areas were those with the highest relative need for health care. Their counterparts in the city used the health services much more. For the larger section of the sample, those with no long-standing illness, the most significant differences were between the various rural locations. Here, both distance to a surgery and distance to the city hospitals were associated with decreasing consultation, out-patient and in-patient rates. The main trend was of young mobile people with high expectations in places with readily accessible health services using those services more than would be expected from their usage rates elsewhere. There was also evidence among the people with no long-standing illness of less prosperous sub-groups being affected by remoteness at the out-patient stage.