The publication of the results of the GP patient survey is always a significant moment—a survey of c850,000 people merits serious attention. The survey happens every year and is an important tool to understand how patients are experiencing their care in general practice.
This year’s survey took place in a very different environment—with fieldwork carried out between January to March 2021 asking people about their experiences of general practice over the previous, extraordinary 12 months. As such we need to be really cautious about generalising the findings and comparing them to previous years, even though it provides a good historical record of how people experienced general practice during the height of the pandemic.
The results were largely positive—with 83 per cent reporting an overall positive experience with their GP practice (compared to 82 per cent the year before) and 71 per cent saying they had a good experience of making an appointment compared to 65 per cent the year before). The data clearly refutes the sweeping generalisation that “general practice has been closed” during the pandemic. The evidence from the survey shows that’s not the case; while there were more telephone appointments than in previous years, 48 per cent of appointments still happened face to face in the GP practice.
Moreover, once people did see or speak to a primary care professional, 9 out of 10 said they felt listened to (89 per cent) and a similar number (89 per cent) said they were given enough time. Both figures represent small improvements from the previous year. Not only was general practice not closed, it was largely meeting the needs of the populations it serves.
However, new covid-19 specific questions in the survey point to some of the challenges that general practice is now facing. 42 per cent of people who said they needed an appointment over the previous 12 months avoided making one. The top two reasons cited were to protect the NHS and fears about catching or spreading covid-19. This suggests patients adhered to the messages they were given about not burdening the system.
Inevitably, there are consequences from asking people to avoid care, where possible, for such a long period of time. General practice is now facing enormous and growing demand, fuelled by a complex mix of seeing those patients who missed out on care over the last year; the implementation of a huge vaccine programme; long waiting lists for secondary care; a social care system facing huge challenges; increasing levels of mental distress in the population; and staff shortages due to shielding, self-isolation, and illness. This means that some patients may find it increasingly hard to access a GP easily when they want to.
Digging down into the data shows that people in deprived areas are more likely to report worse experiences. This inverse care law really needs to be addressed in the government’s drive to improve access to general practice which was a key manifesto commitment. And improving access to care can’t be delivered by general practice alone. When people are in distress—whether they need healthcare, help with living conditions or educational support, or a combination of all of these—the GP is often the first port of call, particularly other services having rising waiting lists, or increasingly high thresholds for access where only the very highest levels of need can be met.
The number of GPs is falling and even with investment in 26,000 extra clinical roles in general practice, demand appears to be outstripping the availability of a workforce to meet it. There’s no single solution—improving access to general practice is complex and will require both recruiting new staff and retaining existing ones. Equally important will be supporting general practice to redesign their services to implement effective team-based and digital models of care in a way that meets the needs of patients. However, to think the answer is only about improving access to primary care misses the point. This has to be about system recovery and understanding the knock-on effects that other stretched and creaking services are having on GP workload.
This year’s GP Patient Survey tells a story of how both GP practices and patients did what they were asked to do to adapt to the situation they were placed in by the pandemic. However, now the inevitable pent-up demand is being unleashed, the risk is that the pressure on practices will increase and the existing challenges around workforce will get worse as the workload becomes unsustainable and people begin to buckle. The only way to address this is by taking a whole system approach to recovery.
Beccy Baird, Senior Fellow, The King’s Fund.
Dan Wellings, Senior Fellow, The King’s Fund.
Competing interests: none declared.