Beyond geography: a catchment-based typology of rural and coastal urgent and emergency care sites in England

Reducing geographical inequalities in urgent and emergency care requires identifying services that support rural and coastal populations. Classifying services by hospital location may misrepresent the communities they serve. We developed a catchment-based typology based on the area characteristics of the population that emergency services serve, rather than their postcode. Using NHS England Emergency Care Data Set for April 2021-March 2024, we linked individual attendances to the patient's residential area rurality and coastal proximity. Site-level rural and coastal attendance shares were compared with national averages using single-proportion tests. We then assessed variations in service pressures across location classes by analysing attendance volume, seasonality, and patient characteristics. The study included 63,924,015 attendances across 347 sites, of which 344 were assigned to four classes: rural-coastal, rural-inland, urban-coastal and urban-inland. Rural-coastal sites had lower average attendance volumes with pronounced summer increases, driven by a higher proportion of attendances from patients living in urban and inland areas. Urban sites (coastal and inland) had higher average proportions of ambulance arrivals and high-acuity attendances. Comparisons of site-level and attendance-weighted measures highlighted heterogeneity within rural classes, with distinct compound demand pressures in rural and coastal UEC services across the year, both in terms of timing and case-mix. The typology provides a transparent basis for service planning, monitoring geographical inequalities and evaluating whether policy and service innovations have different effects across service contexts.