Healthcare in Britain’s rolling hills and quaint country villages is declining because urban-based policies do not work in rural settings, according to a report on Friday.

Up to a quarter of Britons live in the rural areas that make up four-fifths of its landmass but the British Medical Association (BMA) report dents the image of the rural idyll.

The centralisation of health services, combined with the remoteness of some areas and the lack of public transport means many people living in the countryside have difficulty getting to a doctor or the nearest hospital.

“A major problem is the myth of the ‘rural idyll,’” said Vivienne Nathanson, head of ethics and science at the BMA. “Deprivation in rural communities has been ignored for a long time. There is a real case of the haves and have-nots.”

“There are those with private transport who can access services, while those with lower incomes have limited access and choice,” she added in a statement.

The proportion of elderly people living in rural areas is higher than in cities, so country doctors must deal with more chronic illnesses such as heart disease, stroke and mental illness, according to the report.

Cancer is also a disease that affects the elderly. Evidence has shown that patients who live further from specialist health centres have poorer survival rates.

A shortage of family doctors has compounded the problem. In 2000 there were 1.8 practising general practitioners per 1,000 population, compared with an average of 3.3 among European countries

The report called for more innovative health facilities, such as mobile services, to provide better care for patients in rural areas. It said transport needs to be improved and the use of telemedicine, which uses telecommunications technology to provide medical information and care to remote areas, must be expanded.

All medical students should be given the opportunity to choose a rural placement, the report said. Students living in the countryside should also be encouraged to apply to medical school.

“The UK needs to learn from countries like Australia, the USA and Canada which have developed innovative solutions to the problems affecting rural healthcare,” said Nathanson.