The district that needs the NHS most is least equipped to go digital
South Kesteven sits between Lincoln and Peterborough, a district of market towns like Grantham and Bourne surrounded by small agricultural villages, many of them miles from the nearest surgery. It is not obviously disadvantaged in the way a post-industrial city might be, but the numbers that matter tell a different story: 27.9% of working-age residents are economically inactive, a rate the district's own State of the District report (2022) attributes primarily to long-term ill health. That figure compares starkly with the East Midlands employment rate of 75.5%, against South Kesteven's 66.2%. Roughly 22,400 people sit outside the workforce, many of them managing conditions serious enough to prevent employment — and, by extension, requiring regular, reliable NHS contact.
At exactly the moment this population most needs the health service, the NHS is reorienting towards digital-first delivery: online triage tools, NHS App registration, digital appointment booking, and remote consultation as the default starting point. NHS England's 2023 inclusive digital healthcare framework acknowledges the tension openly — around 10 million adults nationally lack foundational digital skills, and 30% of people who are offline describe the NHS as one of the most difficult organisations to interact with.
The question South Kesteven forces into focus is a structural one: what happens when a national digital health strategy meets a population whose geography, health burden, and infrastructure make digital access genuinely difficult?
Long-term ill health as the main reason people aren't working
Long-term ill health is identified in South Kesteven's own State of the District document (2022) as the primary driver of economic inactivity — not early retirement or caring responsibilities. The national context fills in what the local data cannot: more than 2.5 million working-age people across England are economically inactive due to long-term sickness, a figure that has risen by 400,000 since the pandemic. Among this group, 38% live with five or more conditions simultaneously, and 53% report depression or anxiety as a secondary diagnosis alongside their primary illness.
No publicly available sub-national dataset breaks down the district's inactive residents by precise reason — ONS sample sizes at this geographic level are too small for that granularity, so the 27.9% working-age inactivity rate should be read as a strong indicator rather than a direct count of the long-term sick. But the national profile makes the implication plain. People managing multiple conditions are not occasional NHS users; they are frequent ones, with several clinicians, referral pathways, and prescription arrangements to navigate at once. A single person living with chronic pain, type 2 diabetes, and depression has a more complex relationship with the health service than any one digital tool can accommodate — and the 53% figure on depression as a secondary condition matters here, because it is precisely the condition most associated with difficulty managing systems and sustained engagement with bureaucratic processes.
That complexity is the thread running through South Kesteven's figures. The population sitting outside employment because of ill health is, almost by definition, the one with the highest NHS contact frequency — and therefore the one for whom barriers to access carry the greatest cumulative cost.
What online by default actually involves
'Online by default' describes not a single policy but a cluster of operational shifts that have reshaped first contact with a GP. In practices using digital triage tools such as PATCHS or Accurx, patients begin with an online form before any appointment is offered. The NHS App — for booking, records, and prescriptions — is the assumed gateway. Walk-in and telephone routes persist in many settings but are increasingly treated as fallback rather than primary access.
NHS England's own 2023 inclusive digital healthcare framework sets out the stakes plainly. Around 7% of UK households have no home internet; a further million cancelled subscriptions in the past year as costs rose. The groups most at risk from these arrangements — disabled people, those with life-affecting long-term conditions, rural residents with inadequate connectivity, and people in socioeconomically disadvantaged areas — map closely onto South Kesteven's population, though what local GP practices currently retain by way of non-digital routes is not documented in any publicly available source.
The scale of the problem is already measurable nationally. A 2023 BMJ Health Informatics study covering 6,356 primary care providers found a significant association between deprivation and non-activation of the NHS App, corresponding to 4.27 million patients in the most deprived quintiles. The authors described the findings as 'concerning for technologically driven widening of healthcare inequalities' — language from the research itself, not from advocacy.
Lincolnshire ICB's own community engagement adds a dimension that access statistics tend to obscure: some residents actively choose not to use online health services regardless of whether access is available to them. That is a preference, not a deficiency. A system designed around digital participation as the default has no ready mechanism for a considered refusal — which means the case for maintained non-digital pathways extends beyond connectivity gaps alone, and rests partly on a more fundamental question of how people consent to a particular mode of care.
The broadband gap and the 2028 problem
Ninety-four per cent superfast broadband coverage sounds close to universal — but in a predominantly agricultural district of dispersed villages and Fenland farmsteads, the remaining 6% is not evenly distributed. Greater Lincolnshire LEP acknowledges that rural gaps persist behind that headline figure, concentrated in communities furthest from urban exchanges and most reliant on copper infrastructure that underperforms at distance.
Two programmes are intended to close those gaps. A £58 million Project Gigabit contract, signed in February 2024, is extending full-fibre to hard-to-reach rural communities across Lincolnshire and Nottinghamshire. Quickline Communications, backed by the UK Infrastructure Bank, is separately rolling out ultrafast fixed wireless and full-fibre to isolated rural areas including parts of the Lincolnshire Fens where copper lines are least adequate. Both programmes are scheduled for completion by 2028.
That date is the sharpest concrete fact in this picture. NHS digital-first services are being implemented now; the infrastructure that would make them viable for the most isolated rural South Kesteven residents will not be fully in place for several years. The policy direction and the physical network are on different timelines, and the gap falls most heavily on those already using the health service most.
Connectivity, though, is only part of the obstacle. Even where broadband is available, low digital confidence is a documented and distinct barrier — one that infrastructure investment alone cannot resolve. Closing an access gap and closing a skills or confidence gap are different tasks requiring different responses, and conflating them risks treating the problem as solved once the cables are laid.
What's already being tried locally
Lincolnshire ICB's Health and Care Digital Inclusion Strategy 2025–28 is the most substantial formal response to date. It commits to a loan device bank, mapped access to free public computers, a directory of local digital support schemes, and — critically — an explicit pledge to retain face-to-face NHS access for people who cannot or choose not to use online services. The ICB's Lincolnshire Digital Health Toolkit goes further, identifying which communities face the greatest risk from ongoing digitalisation by linking deprivation data to digital exclusion rates and naming rural populations and those with long-term conditions as priority groups.
Concrete, locally replicable provision already exists one district to the north. North Kesteven District Council runs free weekly digital hubs in village halls — including Osbournby, Metheringham, Heckington, Ruskington, and Waddington — where staff and volunteers help residents access NHS services, set up email accounts, and make video calls. The hubs exist precisely because, as North Kesteven's own documentation acknowledges, residents are routinely told 'you can do that online' without anyone checking whether they actually can.
A 2025 qualitative study of community digital health hubs in the North of England provides the best available evidence for what makes these models work: access to devices and Wi-Fi, genuinely accessible community spaces, and consistent personalised support built on trusted relationships. The study found measurable gains in digital skills and social resilience among participants. The critical failure mode it identified was not poor uptake, but inconsistent provision — gaps between areas in what gets funded, sustained, and scaled.
What fair digital health access in South Kesteven would actually require
A 2026 review of digital health equity makes one point that is easy to overlook in the momentum behind online NHS services: digitisation does not automatically improve access. When rollout assumes uniform capability, it can quietly entrench the inequalities it was meant to ease. That caution is not an argument against NHS digital change — it is an argument for designing the local response to it with care.
The evidence from nearby and from the national framework points in a consistent direction. Access is not solved by connectivity alone. It requires confidence, trust, in-person support, and preserved non-digital pathways — and those last routes need to be structural, not residual. The ICB's formal commitment to retaining face-to-face access is the right baseline; the practical question is whether it is actively resourced or merely stated.
South Kesteven currently sits in an awkward position. The instruments and models it needs exist. The Digital Health Toolkit can identify which parts of the district face the sharpest risk from further digitalisation. The village-hub model operating in North Kesteven is directly transferable and costs relatively little to replicate. What is not yet documented publicly is equivalent local infrastructure within the district itself — which is the gap that matters.
A district where roughly a quarter of working-age people are out of work because of ill health depends on healthcare being straightforward to reach. The case for getting digital inclusion right here is not that the NHS should change course — it is that the people who use it most have the least margin for the process going wrong.
- [1] Do community-based digital health inclusion programmes contribute to tackling health inequalities? A qualitative study of a city-wide programme in the North of England. (2025). https://doi.org/10.1186/s12889-025-21418-y https://doi.org/10.1186/s12889-025-21418-y
- [2] Quantifying digital health inequality across a national healthcare system. (2023). https://doi.org/10.1136/bmjhci-2023-100809 https://doi.org/10.1136/bmjhci-2023-100809
- [3] Toward equitable digital health: an integrated framework addressing exclusion, ethics, and implementation across healthcare systems. (2026). https://doi.org/10.1186/s12939-026-02903-1 https://doi.org/10.1186/s12939-026-02903-1