When The King’s Fund and Nuffield Trust published the latest British Social Attitudes survey of NHS satisfaction, I was not surprised that the public view of general practice has fallen. But what was shocking was the drop from 68% to 38% over the space of two years (it was not measured for a year during the pandemic).
This brings general practice in line with the overall satisfaction on the NHS at 36%, Whilst this is still significantly above social care at 15%, it is lower than outpatients (49%) and A&E (39%) and is a cause for concern.
What is concerning the public?
The main underlying issues for the NHS across the whole survey were hospital waiting times, access to general practice and staff shortages.
Is there any good news besides the shocking? Well, there is still significant support for the NHS as free at the point of access, available to all and funded through taxation.
I started to prepare myself for how I would respond if patients brought it up, either head on or more subtly during consultations, or more likely with reception staff. As GPs we know that understanding the patient’s history and context is vital when consulting, so what was the context when the survey was undertaken?
The survey ran from the middle of September to the end of October 2021. At that point, the health news was a combination of a national insurance rise to increase funding for the health and care system and a call for GPs to be seeing patients face to face. It may be that this combination contributed to the results.
The problems predate COVID-19
However, I do not think we can just leave it there with context: satisfaction has been declining over the last few years, from the dizzying heights in 2009 when it was just below 80% and higher than the NHS as whole (64%). The problems predate COVID-19.
So, when patients ask how long it will be for their hip replacement, or why the DVLA has not issued them a new driving licence or if I can treat their dental problem (as well as the problems I can deal with), what will I say?
I will explain that, yes general practice is under pressure, and I am sorry things are not as you might wish. We are busier than we were before the pandemic, seeing more patients, despite fewer GPs and yet it is not enough.
General practice delivered most of the COVID vaccination programme, on top of catching up with its own backlog. Unfortunately, COVID and its legacy is still around, we still need to rightly take precautions, which reduces capacity, and we still have high levels of staff absence as a direct result of COVID. It will take several years for services to recover and in the meantime, we are working hard to maximise the resource we have to meet demand.
How can patient satisfaction rise again?
Will I ever be shocked at a future survey because the satisfaction has increased? Well from 2004 to 2009 GP satisfaction went from 72% to 80%. So, it is possible, but it took a few years and was in the early years of a new contract with investment in general practice.
Staff shortages are a key issue at the moment, but this is not currently being addressed for core general practice, so we should not expect there to be an immediate solution on this. Whilst the extra 26,000 clinical roles promised by the government via primary care networks and the additional roles reimbursement scheme (ARRS) bring extra capacity, their focus could be moved more formally to core general practice, rather than enhanced services and new work being required from networks.
We must also realise that most of tomorrow's workforce is the workforce of today, so retaining the existing workforce is also critical.
In the meantime, the NHS and government need to be realistic about the situation and how long it will take to address. The attention up to now has been focused on elective recovery, however this survey confirms that the public care deeply about general practice as the bedrock of the NHS.
General practice requires attention which is more than highlighting the problems – it needs solutions. Given both the diversity of the population and the diversity of general practice, there is not a one size fits all answer to increasing capacity and productivity. But it is clear that general practice needs support to enable these changes to happen.
- The full report, ‘Public satisfaction with the NHS and social care in 2021: Results from the British Social Attitudes survey’, is published by The King’s Fund and Nuffield Trust and available here.