Hospitals in rural and coastal Britain are struggling to recruit senior medical staff, leaving many worryingly “under-doctored”, a major new report seen exclusively by the Observer reveals. Some hospitals in those areas appointed no consultants last year, raising fears that the NHS may become a two-tier service across the UK with care dependent on where people live.

Disclosure of the stark urban-rural split emerged in a census of consultant posts across the UK undertaken by the Royal College of Physicians (RCP), whose president, Andrew Goddard, has warned that patients’ lives may be at risk because some hospitals do not have enough senior doctors.

Just 13% of consultants appointed in England last year went to hospitals serving mainly rural or coastal areas, with the other 87% being hired by those with mainly urban populations.

In Northern Ireland no consultant recruited in 2018 served a non-urban area. Only Wales bucked the trend, with 39% of newly appointed consultants in such places. No comparable figures were collected for Scotland.

“The results of our census are an incredibly alarming indication of the huge disparities in care across the country. Some rural areas are so severely ‘under-doctored’ that patient lives could potentially be at risk,” Goddard told the Observer.

Some rural areas are so severely 'under-doctored' that patient lives could potentially be at risk Andrew Goddard, RCP

“The sheer dearth of senior doctors in rural communities goes to the heart of the crisis facing our NHS; there simply aren’t enough doctors to treat the number of people in need.”

The trend was consistent in different regions of England. For example, just 13% of consultants recruited last year in the south of England went to work in rural or coastal areas, while only 14% of those hired in the north ended up in such places.

Across England, Wales and Northern Ireland hospitals serving mainly urban areas hired 866 senior doctors, 85% of the total; those with rural and coastal populations made just 153 (15%) senior appointments.

The research did not explore why so many non-urban hospitals find it much harder than those in conurbations to recruit consultants. But local housing shortages, existing doctor shortages at those hospitals putting extra pressure on those who opt to work there, and the fact that many are district general hospitals, rather than teaching hospitals or centres of excellence, may be key factors.

NHS regulators are also concerned by evidence suggesting that geographically remote hospitals are more likely to become embroiled in scandals over the quality of care.

There is a growing divide between London and the rest of urban England, too. Last year the Midlands had more than twice as many vacancies for consultants that hospitals could not fill (161) as the capital (62), while in the north 85 posts remained empty.

Hospitals everywhere are finding it increasingly hard to find suitably qualified consultants. Overall last year hospitals could not appoint someone for 43% of posts advertised. Unfillable consultant vacancies included 25% of posts for cardiologists, 44% for neurologists and 47% for oncologists.

The FCP fears that hospitals are giving up bothering to advertise some consultant posts, as there are so few senior doctors to fill them. The NHS in England alone is short of almost 10,000 medics, official figures show.

Goddard called on Boris Johnson to ramp up the supply of homegrown doctors to ease the NHS’s recruitment problems by doubling the number of places in medical schools. He said: “A major part of the problem stems from the fact that medical schools don’t have enough places to offer those who are keen to study the subject.”

Also urging action on doctors’ pension problems, he added: “Only then can we move closer to providing a National Health Service that is fair and timely for everyone, wherever and whenever they need it,” he said.

Last week Simon Stevens, the chief executive of NHS England, added to growing pressure on the prime minister. He welcomed as “real progress” the recent creation of five new medical schools and a 25% increase in young doctors being educated there.

However, he told the annual conference of NHS Providers, which represents hospital bosses: “Since we’ve also now got an expanding NHS, coupled with more part-time working by doctors with family responsibilities, we’re going to need some combination of a further expansion in UK medical school places or more international recruitment.

“Fortunately in Britain we currently have many more bright and committed young people applying to study medicine and wanting to work as NHS doctors than our universities currently have places for. So the obvious answer is a further increase in medical schools, particularly in parts of the country where there are doctor recruitment shortages.”

The obvious answer is a further increase in medical schools, particularly where there are doctor recruitment shortages. Simon Stevens, NHS chief executive

A spokesperson for the Department of Health and Social Care said: “The NHS [in England] has more consultants now than at any time in its history, with over 17,300 more doctors working in the NHS since 2010 delivering excellent, safe care to patients.

“We also have record numbers of doctors in undergraduate training, recently adding 1,500 training places by opening five new medical schools across England – the majority in rural areas.

“The upcoming People Plan will address how we can ensure all NHS services have access to the doctors they need, including a national programme to tackle geographic and specialty shortages in medicine.”