Public (dis)satisfaction with general practice

Richard Armitage is a GP and Honorary Assistant Professor at the University of Nottingham’s Academic Unit of Population and Lifespan Sciences. He is on X: @drricharmitage

‘Public satisfaction with NHS at lowest ever level.’¹  The 27 March BBC headline was a sobering albeit unsurprising reminder (as if we needed one) of the consequences of the multiple and growing pressures under which the NHS is currently straining.  But what about public satisfaction with general practice specifically? Unfortunately – but also unsurprisingly – the picture is similarly bleak.

The headline derives from the 2023 results of the National Centre for Social Research’s (NatCen’s) British Social Attitudes (BSA) survey, which has been conducted annually since 1983.  The survey asks people what it’s like to live in Britain, including their satisfaction with the NHS and social care, and uses random probability sampling to select British households to participate.  Between 1983 and 2019 the survey used face-to-face interviews, but the modality of data collection was converted to online or telephone interviews in 2020 due to the COVID-19 pandemic, and has remained in this format since (households receive a letter inviting up to two adults to take part online, or over telephone if preferred).  The 2023 survey, which was jointly sponsored by the King’s Fund and the Nuffield Trust, was carried out between 12 September and 31 October 2023, and asked a nationally representative sample of 3,374 people across England, Scotland and Wales about their satisfaction with the NHS and adult social care services overall.  It also asked 1,206 people about their satisfaction with specific NHS services, and for their views on NHS priorities, principles, and funding.²

The BBC headline used one of the survey’s major findings – that, in 2023, public overall satisfaction with the NHS reached an all-time low (since the survey began in 1983).  In response to the question ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?’, only 24% of the public were very or quite satisfied, a 5-percentage point drop from the previous year (a statistically significant difference), while 52% of respondents were very or quite dissatisfied.  While the main reasons for dissatisfaction included insufficient staffing and inadequate funding, the top reason (reported by 71% of those who were dissatisfied) was that ‘it takes too long to get a GP or hospital appointment.’

But what about general practice specifically?  Until 2018, general practice had been the highest-rated NHS service since the survey began.  Since then, public satisfaction has consistently fallen such that, in 2023, both Outpatient and Inpatient care were rated higher than general practice by the public.  In 2023, satisfaction with general practice reached its lowest point since the survey began – only 34% of respondents said they were satisfied with GP services (a non-statistically significant fall from 35% in 2022), while 41% said they were very or quite dissatisfied.  Interestingly, only 82% of respondents in the 2023 survey had used or had contact with general practice in the 12 months prior to participating in the survey, suggesting the responses of 18% were influenced by indirect experiences of general practice such as through the reports of family and friends, or by coverage in the media.

While the survey did not ask participants the reasons for their dissatisfaction with general practice, it can reasonably be assumed from the top reason for overall NHS dissatisfaction that taking too long to see a GP is a major, if not the primary, driver of their negative sentiment.  Yet, the reality on the ground in frontline general practice is that the number of GP appointments taking place has steadily increased over recent years, such that the average number of monthly appointments conducted by each full-time equivalent (FTE) GP in England increased by 18.2% from December 2017 (approximately 417) and October 2023 (approximately 493).³  This reflects the increased productivity of practicing GPs, while the total number of FTE fully-qualified GPs in England decreased by 5.4% between December 2017 (approximately 28 750) and October 2023 (approximately 27 200), which echoes the public’s concern about insufficient staffing in the NHS.

The results of this survey are depressing yet unsurprising – GPs are thoroughly aware of both their increasing workloads and helpless inability to satisfy the relentlessly growing demand, despite our best efforts.  We care deeply about our patients, and are increasingly frustrated by the growing barriers that prevent us from providing the standard of care that we are both capable of and aspire to.  It is difficult to imagine how further gains in ‘productivity,’ ‘innovation,’ and ‘resilience’ could resolve this multi-faceted problem and overcome the sensation of gradually sinking underwater.  I will not opine on solutions here, although the survey’s finding that 48% of respondents would support tax increases to spend more on the NHS (including 62% of respondents from the highest income quartile) indicates the public’s thoughts on the matter.

References

1. N Triggle. Public satisfaction with NHS at lowest ever level, survey shows. BBC News 27 Marcg 2024. https://www.bbc.co.uk/news/health-68669866 [accessed 28 March 2024]
2. D Jefferies, D Wellings, J Morris, et al. Public satisfaction with the NHS and social care in 2023 Results from the British Social Attitudes Survey. The King’s Fund and Nuffield Trust. March 2024. https://assets.kingsfund.org.uk/f/256914/x/48c40ea52b/public_satisfaction_nhs_social_care_2023_bsa_2024.pdf[accessed 28 March 2024]
3. R Armitage. Pressure on GPs in England: appointments, workforce, and patient complexity. BJGP Life 31 December 2023. https://bjgplife.com/pressure-on-gps-in-england-appointments-workforce-and-patient-complexity/

Featured Image created in 2024 by Richard Armitage with DALL·E 3