02 Mar 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.