Satisfaction with GPs – what is the public telling us?

At first sight, the headlines prompted by the recent British Social Attitudes Survey make depressing reading. The poll shows that satisfaction with general practice is falling (to 65%), and dissatisfaction is rising (to 23%), so that for the first time ever the rating has fallen behind that of hospital outpatient services.

However, there might be a positive message hiding amongst the wave of criticism. There is no suggestion that the public is starting to feel the GP role itself is in question, so the intrinsic value placed on GPs seems to remain unchanged.

A look behind the headlines

To put the data in context, analysis of the survey results by the Kings Fund and Nuffield Trust also found public satisfaction with the NHS overall to have fallen from 63% to 57% over the last year, while dissatisfaction had risen by 7% to 29%, an identical trend to the findings for general practice. Older people, over 65, were more satisfied overall, though all age groups showed a reduction in satisfaction rates from the previous year

The 4 main reasons for dissatisfaction were staff shortages, long waiting times, lack of funding, and government reforms. These are not specific to general practice of course, although long waiting times for a GP appointment were included. One of the Kings Fund authors, who notes that the steady decline began in 2009, linked the findings to detail from the national GP patient survey, and she states in her blog that ‘trouble getting through to a surgery on the telephone’ and ‘securing a consultation with a familiar GP’ were key factors. This author, Ruth Robertson, concluded that ‘the data sends an unmistakable message that general practice is in decline’.

Is general practice ‘in decline’?

This is a dramatic statement. Of course, some will say that the well-documented recruitment and retention issues, and rate of practice closures, are clear markers of decline, but do falling public satisfaction ratings indicate this too?

The decreasing ratings are indisputable, however, the reasons behind them are much more complex and relevant to GPs of the future. As it is the time taken to see a GP, and the difficulty of seeing one’s ‘own’ GP, that are causing concern, the role of the GP in a larger healthcare system doesn’t seem in question.

I know that many GPs feel that continuity of care is a vital part of their work, and believe anything that diminishes this will be detrimental to both patient care, and the future of the profession. These colleagues may well feel quiet satisfaction that the survey findings reinforce this view, and indeed, reaffirm that the public continues to value the role of the ‘traditional’ general practitioner?

General Practice, therefore, shouldn’t be seen as in decline, but in crisis. Crisis that can and should be addressed through plans for new service delivery models in the future.

What does it mean for general practice?

If the survey findings are real, rather than artefactual, then one might question whether the trend towards less personalised services, for instance on-line consultations, is likely to lead to further dissatisfaction? Also, many STPs are planning to set up ‘community hubs’ that house a range of services including general practice – these may address the speed of access issue but they are unlikely to offer continuity of care.

Over time, politicians and politics tend to follow public opinion. The innovative GP groups, and there are many, would be well advised to plan for a future that aligns with the wishes of the public, on the basis that services without public support may be less likely to gain support from the government of the day.

  • Fiona French
    Posted at 12:28h, 03 March Reply

    Many patients are indeed questioning the role of the GP. Thousands are congregating online in the prescribed dependent and harmed community seeking help from each other because help is not on offer from GPs and specialists, the very people who have caused the dependence and harm in the first place. Approximately 1 in 4 of the adult population is on a drug of dependence (benzodiazepines, antidepressants, z drugs, opioids). 8 million patients are now taking antidepressants. Public Health England has recently announced a review of prescribed drug dependence such is the level of concern. Patients themselves are petitioning the Scottish Parliament and Welsh Assembly seeking help and support and indeed treatment for those dependent and harmed. Many patients were never warned of the issues of dependence and withdrawal from antidepressants A recent letter to the Times by Prof Wendy Burn and Prof David Baldwin of RCPsych stated that withdrawal symptoms resolve in two weeks which of course is widely different from the experience of many patients. A group of leading academics have requested that the letter be retracted or evidence produced to support this assertion. Meantime we hear nothing from general practice on this most serious of matters. Only one GP in Scotland, Dr Des Spence, has chosen to publicly support the petition to the Scottish Parliament. I myself have been seriously harmed by drugs of dependence and yet it took 4 years and 9 doctors to achieve an honest acknowledgement of that harm. My GPs clearly feel unable to even discuss the subject as I have yet to have a satisfactory, honest discussion of the matter. This is a horrendous state of affairs, If the doctors who prescribe drugs of dependence to millions of patients cannot even acknowledge the harm that they are causing and leading psychiatrists make misleading and inaccurate statements in a national newspaper then something is very seriously wrong. Something very fundamental has been lost when patients can no longer trust their doctors and this has nothing to do with waiting times, access to appointments, or any of the other easy to measure aspects of pubic satisfaction with primary care, I fear that general practice will continue to decline unless doctors start being open and honest with their patients and also open and honest about the widespread iatrogenic harm that is now becoming evident. Medically Unexplained Physical Symptoms is being used as a way of concealing this harm rather than as a means to help patients achieve appropriate help and treatment,

  • Andy D'Alessio
    Posted at 21:18h, 04 March Reply

    Prescribed two benzodiazepines for ten years. Wanted to stop taking them so I started reducing. Slowly became unwell. Went to GP several times over the course of several months. Was told nothing was wrong. Symptoms intensified and became chronically unwell. Then I was misdiagnosed with depression and hospitalised. A duty doctor thought I was suffering from a type of poisoning. I never heard about him again. Then I was subjected to an indescribable hell on earth. For two YEARS! Forcibly withdrawn from both, forcibly pollydrugged on several potions, whilst I descended into a extremely dangerous acute withdrawal. My desperate pleas for help, that something was terribly wrong, were completely ignored. Rectal bleeding was ignored. Everything was ignored. When the true nature of my condition became apparent, I was ostracised. I am still suffering multiple protracted symptoms and I am still ignored. I believe I have suffered permanent damage as a result. We will have a Public Enquiry. You will answer, for what you are inflicting on people. You operate like a mafia. You would rather protect yourselves and a corrupt pharmaceutical industry, than your patients. Despicable!

  • Mark
    Posted at 08:49h, 05 March Reply

    Thanks for commenting Fiona. To my knowledge this isn’t an issue that arose through this particular survey, so probably a separate debate, for another day, but thanks for your interest

  • Fiona French
    Posted at 17:58h, 06 March Reply

    For patients adversely affected, it is too serous to leave for another day and the debate will continue in the national press, on social media and in the medical journals.

  • Carol Leach
    Posted at 09:27h, 23 March Reply

    codeine ruined my daughter’s digestive system. She was given it because the GP refused to diagnose her EDS so didn’t treat her pain appropriately. She came off them when I intervened. She went through hell. and 5 years later she is still unable to eat anything but raw vegan, gluten free, fodmap food because her previously fantastic system that had allowed her to eat just about anything: curry, chilli, sweets and crisps etc, can no longer digest anything complicated.

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