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What are primary care services? 

Primary care services are the ‘front door’ of the NHS and the main way that people access NHS services. There are four main services: general practices, dental practices, optometrists (eye care) and community pharmacies.  

Primary care services account for a large proportion of NHS service providers – for example, there are more than 11,000 pharmacies across England, compared with fewer than 200 accident and emergency departments. Many of these primary care providers act as independent businesses, in contrast to secondary care providers (such as acute hospital trusts) that are run directly by the NHS.  

There are 20 community pharmacies for every 100,000 people in England

How is activity across primary care services changing?

During the Covid-19 pandemic, activity fell across primary care. It has since recovered and is now higher than pre-pandemic levels, except for NHS dental activity. However, rising demand means that access to primary care services, particularly dentistry and general practice, can still be difficult.

Chart showing how Primary care activity has returned to pre-pandemic levels, except for dentistry

How are primary care services changing?

Delivery of primary care services has changed in recent years. The Covid-19 pandemic led to more virtual appointments in general practice – for example, in 2019/20, 15% of GP appointments were online or via the telephone, but by 2022/23 that had nearly doubled to 29%. National initiatives are also encouraging more people to seek care from a wider range of clinician professionals who work in primary care. While the number of full-time GPs has flatlined since 2019, there has been an expansion of other roles in general practice (for example, social prescribing link workers, pharmacists, paramedics, physician associates and physiotherapists) through the Additional Roles Reimbursement Scheme. People are also being asked to go to their ‘Pharmacy First’.

Graph showing the expansion of roles in general practice over the past few years

Spending on primary care services

In 2022/23, the NHS in England spent £17.2 billion across primary care services, equivalent to 9.5% of the Department of Health and Social Care (DHSC) budget. Despite some real-terms growth in primary care spending over the past seven years, the proportion of the DHSC’s budget spent on primary care is shrinking – a fall of more than two percentage points since 2015/16. Funding flows to primary care are complex – for example, there are many sources of funding for general practices, but as with other NHS services, a large proportion of the budget is spent on staff.

Graph showing the amount NHS England spent on primary care services between 2015 and 2023.

Satisfaction with primary care services

Patients have a largely positive view of primary care services. In 2023, more than 90% of patients surveyed were satisfied with the optometry services they had used, and 71% said they had a good experience with their GP practice, while a snapshot survey in 2021 reported high levels of satisfaction with community pharmacies. However, public satisfaction with primary care services has fallen in recent years. The majority of the public was satisfied with GP and dentistry services until 2019, but satisfaction has since fallen significantly.

Chart showing that public satisfaction with some primary care services was low in 2023

Inequalities in accessing primary care services

Accessing primary care services can be particularly difficult for people living in the most deprived areas as those areas have fewer GPs per person. Most people also have to pay for some primary care services (such as prescriptions and dental appointments), which can create an extra barrier to accessing care. For example, in 2023, 8% of lower-income adults reported not getting prescriptions or other medicines because they were unable to afford it, and 19% reported skipping essential dental care for the same reason. People who are willing to pay are also able to access primary care services through independent and private health care providers.

Chart showing that people living in the most deprived areas find it harder to access health services