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Satisfaction with ‘underfunded’ GPs takes ‘devastating’ 30 percentage-point dive



Patient satisfaction with GP services has taken a 30 percentage-point dive since before the pandemic, according to new research.

GP leaders branded the news ‘devastating’, blaming long-term underfunding of general practice as the root cause behind the plummeting scores.

This was also supported by analysts, who said that while the situation was worsened by the pandemic, the squeeze on NHS funding and workforce was ‘decade-long’.

An analysis of responses to the British Social Attitudes Survey found the proportion of patients who were satisfied with GP services plummeted from 68% to 38% since 2019.

The survey of 3,112 people across England, Scotland and Wales was carried out by the National Centre for Social Research (NatCen) in September and October 2021.

And the new analysis, carried out by think-tanks the King’s Fund and the Nuffield Trust, found that:

  • Fewer than four in 10 patients (38%) were satisfied with GP services.
  • A higher proportion – 42% – were dissatisfied with GP services.
  • Satisfaction with general practice is now lower than any other NHS service except dentistry.

The devastating findings come as general practice had been the highest-rated service every year up until 2018, when ratings dropped to a previous record low of 63%.

Overall, NHS satisfaction fell to 36%, with record falls across all individual services, and 41% of patients saying they were ‘dissatisfied’ with NHS services.

The report noted that general practice is the service used by the largest numbers of people, meaning patient dissatisfaction is ‘likely to have had a significant impact on overall satisfaction with the NHS’.

Waiting too long for a GP or hospital appointment was the most common reason given for dissatisfaction (65%), followed by staff shortages (46%) and Government funding (40%).

The report highlighted that the survey took place during ‘unprecedented changes in response to the pandemic’ such as a rise in remote consultations in general practice.

It continued: ‘Action to tackle waiting times for planned care is unlikely to be enough for public satisfaction with the NHS to recover.

‘Addressing pressures on general practice and improving access for patients will be key if satisfaction is to rise in future years.’

When asked what the most important priorities for the NHS should be, the top three cited by survey respondents were:

  • Making it easier to get a GP appointment (48%);
  • Improving waiting times for planned operations (47%); and
  • Increasing NHS staff numbers (47%).           

Dan Wellings, senior fellow at The King’s Fund said: ‘Our analysis reveals an unprecedented drop in public satisfaction with the NHS, which now stands at its lowest level in 25 years. People are often struggling to get the care they need and identified access to general practice, waiting times for hospital care and staff shortages as areas that need to improve. 

‘These issues have been exacerbated by the extraordinary events of the past two years but have been many years in the making following a decade-long funding squeeze and a workforce crisis that has been left unaddressed for far too long.’

BMA council chair Dr Chaand Nagpaul said: ‘The truth is that the NHS in England has been underfunded for so long and we went into the pandemic frighteningly ill-prepared for what was to come. Now staff morale is at an all-time low with doctors leaving the NHS every day.

‘Commitments made by the UK Government, like the recruitment of more GPs, are routinely missed, while at the same time rejecting demands from the House of Lords and over 100 medical organisations for transparent workforce planning.’

He also urged the Government to ‘change course and invest in the workforce’, adding that the BMA was ‘bitterly disappointed’ the spring statement didn’t make ‘any in-roads into tackling the increased demand and pressure that the NHS is now facing’.

He said: ‘The starting point must be to openly acknowledge and tackle the infrastructure deficit in the NHS, beginning with long-term and transparent workforce planning that addresses the shortages and retains our highly skilled workforce through better remuneration, tailored wellbeing support and a change to the punitive pensions taxation rules with immediate effect.’

Dr Rachel Ward, a GP in Oxfordshire who is part of the Rebuild General Practice campaign, said: ‘As a doctor who came into general practice to look after patients, this data is devastating, but it isn’t surprising. Years of underfunding and neglect has left general practice in crisis.  

‘Recruitment and retention of GPs has not kept up with growing demands, yet patient appointments are at an all-time high.  Simply, there are not enough GPs to match patients’ needs – and this is the terrible result. 

‘To patients, we want to say that we are on your side and we feel your pain. To Government, we ask again for more support to rebuild general practice so that GPs can provide the quality of care our patients deserve.’

RCGP chair Professor Martin Marshall said: ‘We are extremely disappointed and saddened by these findings, which reflect a service working under crippling staffing and resource pressures following the pandemic, which has pushed general practice, and the wider NHS, to its limits.’

Warning that general practice was already ‘stretched to its limits’ before the pandemic, he added: ‘GPs and patients want the same thing, and we share patients’ concerns about the difficulties they face in accessing GP appointments.

‘It is vital that today’s report is not used as another opportunity to denigrate and demoralise hardworking GP teams, but that these findings serve as a wake-up call to Government and policy makers on the need for urgent action to boost the GP workforce so that there are enough GPs and practice team members to deliver safe, timely and appropriate care to all patients.’

The British Social Attitudes survey randomly selects households to take part in the survey either online or over the phone. Respondents are asked whether they are ‘very satisfied’, ‘quite satisfied’, ‘quite unsatisfied’, ‘very unsatisfied’, neither or don’t know about a series of NHS services.  

In contrast, the annual GP patient survey, which polled 850,000 patients in England in January and March 2021, found 83% had an overall ‘good’ experience of their GP practice this year and 82% were ‘satisfied with the appointment offered, and accepted it’.  

General practice underfunding

The news comes as last week’s spring budget statement did not pledge any additional funding for general practice or the wider NHS.

The National Insurance rise is expected to raise billions for NHS and social care, however despite this, the Treasury has decided to double the NHS’ annual efficiency target from 1.1% to 2.2% a year – meaning purse strings will need to be tightened further.

The health secretary has also said there will be no additional funding for workforce expansion as part of the work to clear the NHS backlog.

The BMA had urged the Treasury to stump up a further £5-7bn in funding to clear the elective care backlog in England, 10% of which it said must go towards general practice.

The doctors’ union had also called for a drastic expansion in medical school places; increased pay for NHS doctors; a ‘solution’ to ‘punitive’ pension taxation which is prompting GPs to retire ahead of time; a £1bn ‘welfare and wellbeing fund’ for NHS staff; continued free Covid testing for NHS staff; and increased funding for mental health and public health.

In England, this year’s GP contract was imposed upon the profession, after NHS England declined to provide additional support requested by the BMA.

The BMA had asked for:

  • resources to manage general practice pressures;
  • a long-term-conditions recovery fund;
  • reform of childhood immunisations IOS (Item of Service) and QOF (Quality and Outcomes Framework), with ‘additional support for childhood immunisations’ within QOF to enable practices to ‘deliver more for their patients without being financially penalised’;
  • a tapered approach to QOF to support recovery;
  • the provision of long Covid occupational health; and
  • a new contract for general practice.

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READERS' COMMENTS [26]

Not on your nelly 30 March, 2022 7:01 am

Is anyone surprised by this? I’m working 12 hour + days fire fighting. It’s exhausting and I’m terrified of making a mistake. It’s not what the patients deserve and it’s not what we as clinicians deserve. Not sure how much longer I can keep it up for to be honest. The whole system is badly badly broken.

Simon Ruffle 30 March, 2022 9:09 am

I’m really dissatisfied at the booking service at the Quatre de Saisons.
Not that I’ve tried, I’ve been told you can’t get a booking.
Is it clear that the respondents had actually used services or am I just being stupid?

Kevlar Cardie 30 March, 2022 9:19 am
Peter Moss 30 March, 2022 9:30 am

You can only do your best.
This is NOT your fault.
Do NOT blame yourself.
Responsibility lies elsewhere.

Adam Crowther 30 March, 2022 9:34 am

The white flag will again go unnoticed 😩and this will act as further evidence for a poorly performing service. It seems that only the “good” services get increasing investment and this feels like the impossible paradox. So we have an increased national insurance for the NHS and social care yet the NHS have been asked to reduce their spending. So one can only assume this is for social care or to plug the pandemic government inefficient overspend which was “needed”due to their chronic inability to fund services appropriately and thus having reduced them to skeleton offerings !!!!

Dave Haddock 30 March, 2022 9:59 am

More money just gets squandered on nonsense.
Some have abused the crisis to go into hiding, but primarily it’s a systems failure.
The NHS is a bottomless money pit, we need to look at how it’s done elsewhere and change the system.

Nigel Dickson 30 March, 2022 10:37 am

A simple solution to raise public opinon would be to review current telephone handling services – GP practice phones left unanswered – or even worse patients calls stacked until caller has waited 30 minutes and call handling service cuts caller off and you have to call back in as a patient to start at the back of the que. If GP practices could sort this initial problem out then patient satisfaction would leap back to previous levels. Patients understand that GPs and their front line healthcare professionals fronting up delivery of primary care are struggling to cope with massive workload and lack of staff because of current governments historical underfunding of GP infrastructure – but telephone access to practice is General Practice front door that quite frankly appears closed or at best post covid19 remains half shut. Fixing telephone access into practices can be sorted without extra medical or nursing input. If you don’t believe me try ringing into your own practice on the practices main telephone line and see how you get on. Ask yourself why do you have a staff only ex-directory line? When I was a GP looking after nearly 3,000 patients single handedly with 2 receptionists in the morning and 1 in the afternoon we tried to have a 3 rings policy for answering main telephone line – we didn’t have an ex-directory line. I retired in 2015 because I couldn’t bear the destruction of General Practice by this wicked Tory Government – under the health secretary Jeremy Hunt. Who appears to be groundsman turned poacher. But as regards sorting out telephone answering with the right leadership in your practices it can be fixed and patient satisfaction with General Practice improve once more. Your patients know how hard you work but you need to keep them onboard otherwise the day job will become unbearable with disgruntled unhappy patients. Fix the phones.

Simon Gilbert 30 March, 2022 1:51 pm

“Fixing telephone access into practices can be sorted without extra medical or nursing input.”

I suppose we could hire 5 extra receptionists but then we would have to let several clinicians go – how would that help?

Stephen Fowler 30 March, 2022 3:15 pm

I suppose we could hire 5 extra receptionists but then we would have to let several clinicians go – how would that help?

Or you can invest in a modern phone system that allows many more lines into the surgery.
Everyone knows the busiest times on the phone (eg Monday morning) and so you make sure that all your non clinical staff (including those working from home) can be answering the phones for set periods of time and keep the call wait times done.

Sometimes you have to think creatively

Patrufini Duffy 30 March, 2022 3:31 pm

That’s fine. You were working 30% too hard anyway. Get back in line and stop bailing out the NHS and cronies. And the satisfaction for lets say… politicians???

Simon Gilbert 30 March, 2022 3:57 pm

“Or you can invest in a modern phone system that allows many more lines into the surgery.
Everyone knows the busiest times on the phone (eg Monday morning) and so you make sure that all your non clinical staff (including those working from home) can be answering the phones for set periods of time and keep the call wait times done.”

Who would do the referrals, letters, document scanning, results allocation, phoning hospital secretaries to find out the secret email addresses to get correspondence back to them about mutual patients etc?

The problem is not one of scheduling in peaks/troughs, nor is it a recruitment problem. It is an underfunding and capacity problem.

Andrew Jackson 30 March, 2022 4:25 pm

I agree phone lines are a major source of patient frustration and dissatisfaction.
We have done exactly as you suggested with an expensive phone line and we have all staff including PM, secretaries, admin etc manning the phones at the peak 8-9am rush but still the volume exceeds the capacity to answer especially if the team are trying to spend a bit of time collating info about the call that helps get the patient to the right clinician.
We could have an army of employed staff for 1 hour a day to solve this but not many businesses would be sustainable with this model even if we could find staff who wanted that job.
Why the rush at 8am? It is due to demand exceeding capacity and the need to protect a certain number of on the day slots to have a chance of surviving the day. This demand is not for ARRS role appointments-it is for GPs.
None of this will be fixed till we rebalance demand/capacity and NHSE realise that fundamentally there is not enough GP slots to manage the demand.
We have all colluded with this situation developing but it is a political decision and as said not our fault,

Patrufini Duffy 30 March, 2022 6:27 pm

It is not devastating. It is a red alarm to the people you continue to cover up for.
Stop covering up for a lose-lose system.
You will never win
Stop aiming for perfection
Go book your summer holiday and increase your referrals.

Turn out The Lights 30 March, 2022 8:48 pm

Satisfaction of those working in the system is much much lower,when you are in a death spiral this is what happens.My morale is that low look at my face do I give a sh@t,no I do not.You get what you pay for this is the proof.No coming back from this now.

David Church 31 March, 2022 6:12 am

Agree with Nigel Dickson, BUT surveys like this do not differentiate between client unhappiness with doctor and client unhappiness with NHS and Government for underfunding it.
Between now and May, we need to ensure voters are clear on where the problems really lie – but in order to do that, there are certain access and telephone systems that need to be sorted stat.
I locum at 3 surgeries with excellent call management, but my nearest I do not work for because they won’t change from telling patients to call again 8am tomorrow when all triage appointments are full by 0805 am

Nicholas Sharvill 31 March, 2022 10:35 am

Phones. i too am no longer working as a partner but need to ring surgeries. Yes there is a major problem with capacity but the phone systems spend quite a time saying not to ring if covid (quite why GPs as a whole feel covid is not a primary are issue is another story). If there are a fixed number of lines a lot of frustration is built up by the systems being blocked by covid messages
i believe ccg will in many areas fund internet based phone systems that don’t have a number of lines issue though staff still needed . If these staff are not empowered to make f2f appointments then more frustrations will follow. No I don’t have solutions but it wont be too long for the population and the NHS funders to wonder why some gps are earning 6 figure salaries when a lot of the day to day work is being done by staff on NHS band 6 to 8 wages. Others on this forum frequently suggest that GP reduce services (ecg ,ear syringing bloods etc.) Add this to loss of continuity of care one does need to ask what the future holds?

R Croft 31 March, 2022 10:45 am

online services that won’t let appointments be made -advising to phone then 21 minutes of hanging on with messages to use the online option which directed you to the phone line in the first place–then you have to see the GP you are registered with –first appointment 24 April -ok -then phone call back saying she’s not in then as she is on holiday so ring back please and go through it all again…

Sangeeta R 31 March, 2022 12:56 pm

We have nearly 14000 patients and have that modern telephone system and the 6 reception\admin staff answering for the peak shift- we audited 365 calls in the first hour (1 a minute per call handler)-then dropping off to 50-60 per hour after that. We have email\sms messaging\clinical pharmacist triage\HCA \Social prescriber\Mental health worker and physiotherapist on site and we have a HUB at weekends. We use EPS and NHS app for prescriptions…but we still can’t meet demand because we don’t have and can’t recruit enough GP’s. 2.5 partners left [one retires in 12 months] 2 part time salaried- 5 vacancies for GPs in our PCN alone. I retired this week-at 57 due to poor health-guilt ridden and sad. This is London-we’re all burning out.

Patrufini Duffy 31 March, 2022 2:14 pm

Dentists are all at 4.5* on their Google reviews. Funny that isn’t it?

Samir Shah 31 March, 2022 10:07 pm

Sangeeta is right. The phone line problem is a symptom of the chronic underresourcing of general practice. Which is why we have a double whammy of patients having their difficulties and at the same time GPs burning themselves out trying to hold the Fort and do our best for patients who suffer, while being beaten with a smelly brown stick by the powers that be and certain media.

Samir Shah 31 March, 2022 11:02 pm

Phone systems could be better.though. Agree there, even if to highlight the above.

David jenkins 3 April, 2022 10:30 am

i don’t suppose they did the same survey for the “service” the hospitals are providing ? or the ambulance service ?

didn’t think so !

David jenkins 3 April, 2022 10:48 am

and another thing…………….try phoning a surgery in wales.

you’ll get a message in welsh, then in english, telling you to “press 1 for welsh or 2 for english”

then you’ll get another message in your chosen language telling you that if you’ve gone blue, or are bleeding to death, to “replace the handset and dial 999 immediately”. at the end of that – which clogs up the phone line for over a minute and acheives nothing at all – you’ll be told you are in a queue and will be answered shortly.

this fiasco is WELSH ASSEMBLY GOVERNMENT POLICY, surgeries cannot “not do it”. phone lines are thus all clogged up, which is why you can’t get through.

please DON’T complain to the surgery – complain to your assembly member – or better still, your MP. your MP will tell you there is nothing he/she can do, as health is devolved – but at least westminster will know what a pig’s arse the welsh politicians have made of it !!!

Dave Haddock 5 April, 2022 11:25 am

The obvious mechanism for increased funding for GPs would be a small charge for booking an appointment, perhaps £10.
I am predicting that this would miraculously reduce workload as well increasing income.

Meanwhile, seeing patients face to face, rather than repeatedly fobbing them off by phone before having to see them anyway might help both with workload and patient satisfaction.

David jenkins 5 April, 2022 1:38 pm

Dave Haddock

it wouldn’t increase income at all……………do you honestly imagine the government would let us keep all those tenners ? not a prayer !!

what it would certainly do is INCREASE our workload because we would presumably have to document all these tenners before handing them over.

this would be necessary to stop all these nasty, lazy, greedy GPs pocketting the odd £10 to put towards the membership of the golf club.

oh – and to keep some 9-5 jobsworth off the unemployment figures !

Patrufini Duffy 5 April, 2022 8:16 pm

When I dive, I do a double summersault and back flip. Try not to belly flop of the altruism board.