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Public satisfaction with GP services drops to lowest level in 35 years


The latest results of the National Centre for Social Research’s British Social Attitudes (BSA) survey make sobering reading for general practice – usually the highest rated NHS service in the survey. Public satisfaction with general practice dropped by 7 percentage points in 2017 to 65 per cent, the lowest level since the survey began in 1983.

While a one-year drop in GP satisfaction is worrying, the long-term trend is even more alarming. Satisfaction has been steadily decreasing for close to a decade from a high of 80 per cent in 2009. Meanwhile, satisfaction levels with other NHS services have not experienced such a steep decline and have tended to fluctuate year on year. And as respondents are more likely to have used GP services rather than the other services covered in the survey, this is likely to be an accurate reflection of their recent experiences.

Satisfaction is usually highest among older respondents (Figure 1). For example, in 2017, satisfaction among those aged 65 or older was much higher (77 per cent) than among those aged 18 to 64 (62 per cent). However, this year satisfaction has fallen in all age groups.

Line graph showing drop in public satisfaction with GP services for different age groups (very or quite satisfied)

Another way to look at satisfaction data is to calculate net satisfaction: satisfaction minus dissatisfaction. A high-performing service should aim to shift respondents from the dissatisfied category into the satisfied category, and this measure tracks their success in doing that.

Figure 2 shows changes in net satisfaction with general practice along with satisfaction with four other NHS services –inpatient, outpatient, accident and emergency (A&E) and the NHS overall.

Line graph showing net public satisfaction with NHS services and the NHS overall 1983-2017 (satisfied minus dissatisfied)

It shows that over time there has been a striking change in how the public view general practice compared to other parts of the NHS. From the early 1990s through to the late 2000s net satisfaction with general practice was more than 20 per cent higher than net satisfaction with the other parts of the NHS. For example, in 1999 net satisfaction with general practice was 61 per cent, while net satisfaction with inpatients (the next highest rating) was 41 per cent, outpatients 34 per cent, A&E 28 per cent and the NHS overall just 13 per cent. In market research terms, general practice was definitely the market leader, in line with its international reputation as the jewel in the crown of the NHS.

However, this is no longer the case. Net satisfaction with GP services in 2017 (43 per cent) was lower than net satisfaction with outpatients (52 per cent) and around the same as satisfaction with inpatients (41 per cent).

Why has satisfaction dropped so significantly in recent years? The BSA does not ask respondents about their dissatisfaction with general practice explicitly, but when it asks patients who are dissatisfied with the NHS overall why this is, one of the top reasons is long waiting times for GP and hospital appointments. This suggests that difficulties accessing care are part of the problem. The national GP patient survey provides more insight: key experience measures have been declining since 2012 (the earliest year of comparable data available). These measures include patients finding it harder to get through to the surgery on the phone, harder to see their GP of choice (which affects continuity of care, something that we know is key to keeping patients healthy and out of hospital) and rating their overall experience of the surgery more negatively.

What does this mean for policy-makers? First, the BSA is a gold standard measure of public opinion, so policy-makers should take it seriously. Second, the data sends an unmistakable message that general practice is in decline.

The results are not surprising given the pressures on general practice. These pressures are driven by increases in patient demand, caused by a range of factors including an increasing number of patients with multiple chronic conditions and complex needs, and a growing number of treatments available. The situation is exacerbated by a workforce crisis: more GPs and other primary care staff are needed, but GP numbers at the end of 2017 were lower than in 2015.

While the government is still committed to recruiting 5000 more GPs (with a large proportion coming from overseas), meeting these demands will also require changes to the way we deliver general practice. This is something that The King’s Fund is currently exploring through a project looking at innovative models of general practice in England and elsewhere.

Unless the government and general practices respond to these challenges, public satisfaction levels will continue to slide, and the jewel in the crown of the NHS will struggle to regain its royal status.