A local doctor’s surgery closes—and years later, people affected by that closure are more likely to support the populist right. The surprising link is not just healthcare; it is trust in the state. The argument begins with a bargain people expect from government: citizens pay taxes and obey the law, while government delivers public goods such as safety, roads, education, and healthcare.

Here, the study argues that direct experience with declining public services creates grievances with the political establishment and increases the appeal of populist right parties. The study follows the universe of GP practice closures in England between 2013 and 2023, using administrative data from the NHS.

It then examines patients’ experiences, finding that closures reduce satisfaction and produce more negative patient reports about the experience of making appointments. Finally, it examines political choices, using large-scale annual panel datasets to show that direct exposure to a closure increases support for the populist right.

The study first looks at patient reports, asking whether closures bring lower satisfaction and more negative experiences when people try to make appointments. It then examines whether direct exposure to a closure increases support for the populist right.

When a local doctor’s practice closes, nearby residents may lose a familiar route to care. These closures are spread across England, with especially dense clusters around major urban areas, showing this is a widespread access problem rather than an isolated event.

The patient results point in the same direction: people forced to switch practices after a closure, or people whose practice absorbs patients from a closing practice, report declining satisfaction with the service. Those results are consistent with the idea that closures generate grievances among affected patients.

The voting results suggest that closure of GP practices increases support for the populist right among affected voters. The effect is nearly immediate and persists across both data sources, lasting for at least four to five years. It is relatively small, but it is consistent across the two independent samples.

Here is the surprise: the effect is much greater in areas with higher immigration and more new migrant registrations at local practices than in areas where immigration is lower. The results suggest that the populist right has been successful in framing public-service decline as the result of increased competition from migrants.

This relationship appears only for the populist right, not the other party families examined. The broader conclusion is that public-service decline can drive grievances and, in turn, support for the populist right. When the state falls short of its obligations, voters may respond to anti-establishment arguments about a political elite disconnected from ordinary people.

Those effects become stronger when service problems are combined with concerns about competition with immigrants, making voters more likely to punish established parties by supporting the populist right. Across different analyses and sources of data, the study finds consistent causal evidence that exposure to declining public services fuels support for the populist right.

The effects are relatively small, but they persist over time and matter in elections, where changing one’s vote can be difficult. For patients, that means exposure to declining public services can shape political choice by fueling support for the populist right. The study finds that declining public services can push voters toward the populist right, especially where immigration concerns are stronger.

Keeping everyday services working may therefore matter for politics as well as health.