NHS micro-management branded "breath-taking" and "inappropriate" in House of Lords debate over rural health provision

She questioned whether costs for health-care, which can be higher than urban areas, were factored into policy-making.

The Baroness also asked whether recommendations from a report in the House of Lords back in 2016 on ‘rural-proofing’ had been acted on as she had seen no evidence, and, why the government had failed to act on recommendations in an All Party Group publication on Rural Health and Social Care, that had been published last year to improve provision for patients.

In particular she outlined that poor connectivity, both broadband and travel, was an issue and that electronic prescriptions can’t be delivered in some rural areas and remote consultations to patients and other telehealth innovations are unable to be delivered.

There had been progress in connectivity she added, singling out North Yorkshire County Council for its efforts – but there was still up to 5 per cent of areas that still hadn’t been reached.

Baroness McIntosh of Pickering, MP for Thirsk and Malton between 2010 and 2015 and MP for the Vale of York from 1997, also added in her address to the House, that when she raised the issue with Lord Markham, the Parliamentary Under Secretary of State at the Department of Health and Social Care – he was unaware of the issue.

In addition, Alzheimer’s UK had contacted her with concerns over irregularities in dementia diagnosis in rural areas and that during a recent spike in chicken pox and children being prescribed penicillin, rural practices have not been properly reimbursed for the costs.

She said: "I want to raise the role of NHS England in this regard, which is clearly undermining the role of GPs and demoralising practitioners and therefore patients. The level of micromanagement is breathtaking. It has removed all the regular interface that GPs would normally have with patients in rural areas—and, I accept, in other areas as well. You can no longer access minor injuries treatment; you can no longer have your ears dewaxed; you can no longer have a routine check-up in the way a GP used to give before, giving the GP the opportunity to question patients about their general health and mental welfare.

"NHS England has been asked to focus on a one-size-fits-all solution, oblivious to the fact that what may work in an urban area is totally inappropriate and cannot necessarily be delivered in a rural one, across a highly isolated, sparsely populated, deeply rural area with, in addition, many elderly patients with a number of comorbidities. This level of micromanaging is inappropriate and must cease, and clinicians must be allowed to decide on treatment.”

One-fifth of the population live in remote, rural and coastal communities. This amounts to 9 million people, which is more than the population of Greater London but there is a disparity in care.

Baroness McIntosh of Pickering added: "I regret that, at the moment, the Government seem blind to the challenges of delivering healthcare in rural as opposed to urban areas. I hope that the contract about to be negotiated will provide an opportunity to revisit this issue and ensure both that there is a better balance between primary and secondary care spending and that rural areas are identified as a priority.”

In response to the debate, Lord Evans of Rainow, summing up said some systems for fundings and formula are significantly above or below the target of where their allocations should be and NHS England will be managing that.

He added that the government was taking action to improve broadband and mobile phone connectivity and that 73 per cent of premises can now access broadband, compared to just six per cent in 2019.

£4.5bn worth of extra funding had been made available for community care by 2023-24 and in January of this year, the government announced they will publish a major conditions strategy covering six conditions including dementia. An interim report on the major conditions strategy will be published in the summer.