Primary and community care

In our latest update we look at trends in the quality of primary and community care.

Indicator update

Published: 14/08/2020

Primary care services are often a patient’s first and main point of contact with the health system, and act as a ‘front door’ to accessing services. High quality, adequately funded and resourced primary and community care can make health systems more efficient and improve patient experience.

The coronavirus (Covid-19) outbreak has led to dramatic changes in general practice, with fewer patients presenting at GP surgeries and increasing numbers of appointments taking place by telephone or online, rather than face-to-face. The NHS Long Term Plan set a target that every patient will have the right to access online GP consultations by 2023/24, and the pandemic has accelerated the adoption of technology, with many GP practices offering a ‘digital first’ service.

This month at QualityWatch we’ve updated our primary and community care indicators, as well as those looking at rates of emergency admissions for conditions that can be better managed in primary care. The latest data presented here for antibiotic prescribing and emergency admissions are for before the Covid-19 outbreak. The 2020 GP Patient Survey was carried out between 2 January and 6 April, however only a small percentage of responses were received after the lockdown began and analysis carried out as part of the survey found that overall results were unlikely to have been affected by the pandemic. The most recent data on GP referrals is from June 2020 and reflects changes in service use during the pandemic. A summary of our primary and community care indicators is shown below. Click on the links for more detailed content and analysis.

Access to GP services

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  • The proportion of patients who found it easy (‘very easy’ or ‘fairly easy’) to get through to someone at their GP surgery on the phone fell from 81% in 2012 to 65% in 2020. Those who found it ‘not at all easy’ increased from 5% to 13% over the same time period.
  • Between 2018 and 2020, the proportion of patients who found it ‘very easy’ or ‘fairly easy’ to use their GP practice’s website to look for information or access services decreased slightly from 78% to 75%.*
  • Between 2018 and 2020, the proportion of patients who said that their appointment took place ‘on the same day’ as initially trying to book remained constant at 35%, but those who said it took place ‘a week or more later’ increased from 25% to 28%.*
  • Continuity of care in general practice has worsened over time. Between 2012 and 2017, the proportion of patients who ‘always or almost always’ saw or spoke to the GP they preferred decreased from 42% to 33%. And between 2018 and 2020, the proportion fell from 26% to 22%.*

Confidence and trust in clinicians

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  • The proportion of patients who ‘definitely’ had confidence and trust in the healthcare professional they saw or spoke to during their last general practice appointment decreased slightly from 69% in 2018 to 68% in 2020.*

Do patients feel involved in decisions about their care?

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  • Between 2018 and 2020, the proportion of patients who were ‘definitely’ involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment decreased slightly from 61% to 60%. In 2020, 7% of respondents were not involved as much as they wanted to be.*

Patients’ overall experience of GP and dental services

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  • The proportion of patients who had a good overall experience (‘very good’ or ‘fairly good’) of their GP surgery decreased from 88% in 2012 to 85% in 2017. And between 2018 and 2020, the proportion of patients who had a good overall experience decreased from 84% to 82%.*
  • Between 2012 and 2016, the proportion of patients who had a good overall experience of NHS dental services increased slightly from 83% to 85%, then remained constant until 2020 when it fell slightly to 84%.

* Note that these results from GP Patient Surveys carried out from 2018 onwards are not directly comparable with previous surveys. This is due to changes in the questionnaire and the inclusion of 16-17-year-olds. Not all time trend data was affected at a national level, so some survey questions are comparable over time.

Antibiotic prescribing

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  • Reducing inappropriate antibiotic prescribing reduces the risk of drug resistant infections developing. While most antibiotic prescribing occurs in general practice (72% of total prescribing in England in 2018), consumption in this setting has decreased by 13% since 2014.
  • The rate of antibiotic prescribing in primary care in England per 1,000 inhabitants is about average among the OECD comparator countries. Antibiotic prescribing is high in Greece and France and low in Austria and the Netherlands.

GP referrals

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  • Between 6 January and 15 March 2020, the number of GP referrals to consultant-led outpatient services fluctuated at around 360,000 referrals per week. From the week starting 16 March, the number of referrals began to fall dramatically following the Covid-19 outbreak, reaching a low of 53,268 in the week starting 13 April.
  • This may be due to the scaling back of hospital activity or a reduction in the number of patients presenting at GP surgeries. Since then, the number of referrals has begun to increase but remains considerably lower than before the pandemic.

Potentially preventable emergency admissions

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  • Ambulatory care sensitive (ACS) conditions are conditions where effective community care can help prevent the need for hospital admission. Urgent care sensitive conditions are acute exacerbations of urgent conditions that a care system should treat and manage close to home without the need for hospital admission in as many cases as possible.
  • Between 2008/09 and 2019/20, the rate of emergency admissions per 1,000 population for these conditions remained relatively stable.
  • Rates of emergency admissions for ACS and urgent care sensitive conditions improved for people aged 0 to 15 and 64 to 74 but worsened for people aged 25 to 34, and 85 or over.
  • Between 2008/09 and 2019/20, the rate of emergency admissions increased for falls, cellulitis, urinary tract infections, COPD and acute mental health crisis, but decreased for angina and non-specific chest pain.

Emergency admissions for children with chronic conditions

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Asthma

  • Between 2008/09 and 2019/20, the rate of emergency admissions for asthma in children and young people aged 5 to 19 remained relatively constant. But the rate in children aged 0 to 4 years decreased considerably. This could largely be due to a reduction in over-diagnosis of asthma in young children by clinicians.
  • In 2019/20, the rate of emergency admissions for asthma in children aged 5 to 9 was over 1.5 times as high as the rate in children aged 10 to 14, and over 2 times as high as the rate in young people aged 15 to 19.

Diabetes

  • The rates of emergency admissions for Type 1 diabetes have decreased for children aged 0 to 14 and remained roughly stable for young people aged 15 to 19.
  • There has been a striking increase in emergency admissions for diabetes in young people aged 20 to 24, from 66 emergency admissions per 100,000 population in 2008/09 to 94 per 100,000 population in 2019/20. The worsening trend is likely to be explained by fragmented and variable service quality, as young people with diabetes transition to adult services.

Epilepsy

  • Overall, emergency admissions for epilepsy have remained relatively constant over time for children and young people. Children aged 0 to 4 have the highest emergency admission rate for epilepsy, at 102 per 100,000 population in 2019/20.

For more information and analysis of primary care, see these Nuffield Trusts blogs and reports:

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