Nada Khan is an Exeter-based GP and an NIHR Academic Clinical Lecturer in General Practice at the University of Exeter. She is also an Associate Editor at the BJGP.
General practice remains one of the few parts of the NHS consistently trusted by patients. With only one in five people now saying they are satisfied with the NHS overall, patients continue to express confidence in their GPs – the 2025 GP Patient Survey found that over 90% of patients reported confidence and trust in the healthcare professional they last saw.1 However, the nature of this trust, and the structures that sustain it, are being challenged and eroded by the way general practice is changing.
A shifting foundation
A recent study in the British Journal of General Practice highlights these shifting dynamics of trust between GPs and patients.2 The study looked at more than six thousand practices in England and found that higher confidence and trust were associated with higher percentages of GP appointments, higher levels of continuity and more face-to-face appointments. These findings reinforce that the relational aspects of general practice, like seeing a GP, seeing them in person, and seeing them again over time, remain central to patient trust. This study shows associations, not causation, but the signal here suggests that when continuity and personal connection declines, trust weakens.
The rise in the transactional model
…when continuity and personal connection declines, trust weakens.
If patient trust is based on that personal connection with a GP, it is being tested at a time of widespread change and reorganisation in general practice. The Modern General Practice Model is reshaping primary care through an emphasis on triage, multidisciplinary staffing and digital access.3 Alongside these changes, the recent NHS 10 Year Health Plan for England proposes further reforms to the organisation of general practice, including a growing focus on neighbourhood care hubs and digital access, shifts that will continue to redefine how relationships between patients and clinicians are formed and sustained.4
The aims of these shifts are to improve access and efficiency, but these transactional models drift from the relational heart of general practice, and create a ‘paradox’ of access that amplifies work for patients and clinicians.5 Patients often begin with an institutional trust in general practice, but relational trust develops only through repeated, consistent encounters with the same clinician.6 As general practice becomes more fragmented and system-led, institutional trust is increasingly asked to stand in for relational trust. A study from Norway suggests that this relational foundation remains critical, even in digital contexts. Older adults reported that they trusted e-Consultation systems only when underpinned by an existing relationship with their GP. Relational trust was a key factor in making institutional or technological trust possible.7
Alongside these structural shifts, the GP workforce crisis is deepening. Luisa Pettigrew and her colleagues showed in a recent paper that one in three licensed GPs in England no longer work in NHS general practice, many having moved abroad, shifted to part-time roles, or left the profession altogether.8 This loss of stable, long-term GPs is being mitigated against in some areas by increasing use of locums, additional roles team members, and remote consultations, strategies that may preserve one conceptualisation of access, but further erode continuity and risks weakening that relational basis for trust.9
Unequal trust
As continuity is disrupted by fragmented care and workload pressures, the relationships that sustain trust become harder to maintain.
Trust is not evenly distributed across the population demographic. In 2025, the NHS Race and Health Observatory released a report which shows that patients from minority ethnic groups are significantly more likely to feel unheard or ignored in primary care. Over a quarter of Bangladeshi and Pakistani respondents said their health concerns were rarely or never acted upon, and ethnic minorities were more likely to not feel confident engaging with remote consultations. Nearly half of respondents felt they had been treated differently by their primary care clinicians due to their ethnicity or other personal characteristics, which may reflect long-standing feelings of structural inequities and experiences of discrimination. The recent paper by Baker and colleagues in the BJGP echoes this finding, with practices serving more deprived and ethnically diverse communities reporting lower patient confidence and trust.2 These findings matter because trust directly shapes how people engage with their GPs and the healthcare system. Mistrust in the healthcare system and doctors can delay help-seeking and has a disproportionate impact on ethnic minority update of preventative care like vaccinations, or menopause care.10,11 Trust is a practical problem for general practice, one that affects the quality and safety of care delivered to diverse community groups.
Rebuilding the relational core
General practice is a complex intervention that rests on core relational practice, and is built on continuity, contextual knowledge, and professional competence.12 As continuity is disrupted by fragmented care and workload pressures, the relationships that sustain trust become harder to maintain.
Building trust depends on restoring the conditions that allow relationships between patients and GPs to form and persist, and requires us to address the structural drivers of fragmentation, including workforce instability, short-term contracts, and models of access that prioritise speed over relationships and create a paradox of access. Trust is not evenly distributed, and rebuilding it in communities who have faced years of structural inequalities will require time, consistency, and a demonstrable commitment to equity.
As general practice evolves, reforms should account for this slow burn of trust over time, which is not an easy ask within the short political and funding cycles that shape the NHS. A system can deliver rapid access yet still fail its patients if the relationships that make care effective are lost. The priority now is to ensure that efforts to improve access do not come at the cost of the trust that underpins effective care.
References
- NHS. GP Patient Survey 2025 [Available from: https://www.gp-patient.co.uk/
- Baker R, Levene LS, Couchman E, Newby C, Freeman GK. Factors influencing confidence and trust in health professionals: a cross-sectional study of English general practices. Br J Gen Pract. 2025.
- Modern general practice model 2024 [Available from: https://www.england.nhs.uk/gp/national-general-practice-improvement-programme/modern-general-practice-model/.
- Fit for the future: 10 Year Health Plan for England. Department for Health and Social Care: NHS England; 2025.
- Voorhees JB, S.; Waterman, H.; Checkland, K. A paradox of access problems in general practice: a qualitative participatory study. British Journal of General Practice. 2024.
- Tarrant C, Dixon-Woods M, Colman AM, Stokes T. Continuity and trust in primary care: a qualitative study informed by game theory. Ann Fam Med. 2010;8(5):440-6.
- Kristiansen E, Atherton H, Austad B, Bergmo T, Norberg BL, Zanaboni P. Older patients’ experiences of access to and use of e-consultations with the general practitioner in Norway: an interview study. Scand J Prim Health Care. 2023;41(1):33-42.
- Pettigrew LM, Bharmal AV, Akl S, Exley J, Allen LN, Petersen I, et al. Trends in the shortfall of English NHS general practice doctors: repeat cross sectional study. BMJ. 2025;390:e083978.
- Grigoroglou C, Walshe K, Kontopantelis E, Ferguson J, Stringer G, Ashcroft DM, et al. Locum doctor use in English general practice: analysis of routinely collected workforce data 2017-2020. Br J Gen Pract. 2022;72(715):e108-e17.
- Bhanu C, Gopal DP, Walters K, Chaudhry UAR. Vaccination uptake amongst older adults from minority ethnic backgrounds: A systematic review. PLoS Med. 2021;18(11):e1003826.
- MacLellan J, Dixon S, Bi S, Toye F, McNiven A. Perimenopause and/or menopause help-seeking among women from ethnic minorities: a qualitative study of primary care practitioners’ experiences. Br J Gen Pract. 2023;73(732):e511-e8.
- Reeve J, Allsopp G, Mulholland M. Standing up for general practice. Br J Gen Pract. 2025;75(750):4-5.
Featured photo by Tim Marshall on Unsplash.
