Access-driven policies ‘may lead to lower confidence’ in general practice, study finds
Government policies aimed at improving access to general practice may lead to ‘lower patient confidence’, a new study has found.
The study, published in the British Journal of General Practice, argued that preserving features of relationship-based care in general practice is needed to maintain patients’ trust and confidence in healthcare professionals.
The research looked at published data including the GP patient survey and QOF data across 6,196 English general practices from 2023 to 2024, covering 99% of active practices, and found that higher confidence and trust in healthcare professionals was associated with higher percentages of patients seen by GPs, or face to face by any other healthcare professional.
It warned that lack of trust can lead to ‘inappropriate underuse or overuse of health care’ and it can influence health behaviours, the acceptance of health advice and health outcomes.
The researchers said that practices themselves ‘should be cautious’ about further reducing appointments that are with GPs or are face to face with any healthcare professional, as this could affect patient confidence.
They also argued that until more evidence becomes available about the impacts on patient behaviours, outcomes and use of services, policymakers ‘should pause strategies’ that undermine the relationship model – described as a model where ‘over repeated consultations, the patient becomes familiar with a specific healthcare professional’.
They said: ‘Higher confidence and trust was associated with higher percentages of appointments with GPs and that were face to face.
‘Higher confidence and trust was also associated with higher levels of continuity and of patients’ needs being met at their appointments.’
The study said that ‘easy, equitable access’ and relationship-based care are both needed, but achieving this requires ‘adequate resourcing of general practice’.
It concluded: ‘This study cannot establish causation but does suggest that strategies to improve access that lower continuity, reduce the percentage of appointments that are with GPs, and increase remote consulting may lead to lower confidence and trust in healthcare professionals.
‘Our findings question the wisdom of adopting largely transactional models of general practice to replace relationship models.
‘In improving access, strategies should be avoided that risk weakening patients’ confidence and trust in their healthcare professionals.
‘Declining trust in healthcare professionals matters because trust influences patients’ use of resources, their health behaviours, and their outcomes.’
Last week the BMA’s GP committee deputy chair warned that Government-mandated online access requirements mean GPs ‘sit in front of a screen for hours and hours’, resulting in fewer face-to-face appointments for patients.
His comments come as NHS England launched ‘a new GP online access campaign’ to ‘increase knowledge and use of online forms’ as a route for patients to contact their GP.
And last month, another study argued that Government-imposed policies on online GP access and the effort needed to keep systems working are taking staff away from work that would be ‘more effective’.
BMA leaders told Pulse that GPs spending more time doing admin than spending face-to-face time with their patients ‘is not the success the Government thinks it is’, in a row around the contract changes which has caused ‘confusion and anger’ among GPs.
Pulse previously revealed that GP practices were spending time equivalent to more than 200,000 appointments a week implementing the changes.
A Pulse white paper and investigation last year exposed a widening gap between how access is discussed in policy circles vs. how it is actually experienced in practices.
