A patient’s first point of contact in the healthcare system is most often in primary care services. They act as the ‘front door’ to the NHS. There are around 307 million patient consultations at GP surgeries each year, compared to 24 million A&E attendances. Good access to primary care services that are adequately funded and resourced is therefore vital.
Reforms are happening in general practice. The NHS Long Term Plan set a target that over the next five years, every patient in England will have the right to access online ‘digital’ GP consultations. GP practices are also being funded to form primary care networks, where practices work together and in collaboration with community, mental health, social care, pharmacy, hospital and voluntary services in their local areas.
This QualityWatch update looks at how the quality of primary care has changed over time. It uses hospital data to analyse rates of emergency admissions for conditions that can be better managed in primary care. Prescribing data gives us an indication of how successfully we are reducing the volume of antibiotics prescribed. And GP Patient Survey data tells us about people’s experiences of general practice.
Below is a summary of our primary care indicators, with links to more detailed content and analysis.
For more information about primary care, see these Nuffield Trust reports:
- Improving access and continuity in general practice
- Divided we fall: getting the best out of general practice
Access to GP services
- 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 68% in 2019. Those who found it ‘not at all easy’ increased from 5% to 11% over the same time period.
- In 2019, one third of patients stated that their appointment took place ‘on the same day’ as initially trying to book, but one quarter said that it only took place ‘a week or more later’.
- 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 prefer decreased from 42% to 33%. And between 2018 and 2019, the proportion fell from 26% to 24%.*
Patients’ overall experience of GP services
- 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. In 2018, 84% of patients had a good overall experience and this declined slightly to 83% in 2019.*
- In 2012, 3.6% of patients had a poor overall experience (‘very poor’ or ‘fairly poor’) and this increased to 6.5% in 2019.*
- Between 2012 and 2019, the proportion of patients who had a good overall experience of NHS dental services increased from 83% to 85%.
Confidence and trust in clinicians
- In 2019, 68% of patients ‘definitely’ had confidence and trust in the healthcare professional they saw or spoke to during their last general practice appointment. This compares to 79% of adult inpatients who said that they ‘always’ had confidence and trust in the doctors treating them in 2018.
Involvement in decisions about care
- During their last general practice appointment, 61% of patients were ‘definitely’ involved as much as they wanted to be in decisions about their care and treatment in 2019. This compares to 76% of women who were ‘always’ involved in decisions about their care during labour and birth in 2018. Only 53% of community mental health service users ‘definitely’ were involved as much as they wanted to be in agreeing what care they will receive in 2018.
Supporting patients to manage their long-term condition
- Between 2012 and 2017, the proportion of patients who ‘definitely’ had enough support from local services or organisations to help them manage their long-term health condition(s) decreased from 54% to 51%. In 2019, only 42% of patients ‘definitely’ had enough support in the last 12 months, and 37% had not received enough.*
- Only 30% of patients aged 16 to 24 ‘definitely’ felt supported to manage their long-term condition in 2019, compared to 53% of patients aged 65 to 74.
- In 2017/18, a smaller proportion of people from the most deprived areas (54%) felt supported to manage their long-term condition compared to people from the least deprived areas (65%).
Potentially preventable emergency admissions
Ambulatory care sensitive (ACS) conditions are conditions where effective primary and community care can help prevent the need for hospital admission.
Urgent care sensitive conditions are acute exacerbations of urgent conditions which a care system should treat and manage close to home and without the need for hospital admission in as many cases as possible. Although some of these admissions are necessary, a high rate may indicate avoidable admissions.
- Between 2008/09 and 2017/18, the number of emergency admissions for ACS conditions and urgent care sensitive conditions increased by 9% and 11%, respectively. However, rates of emergency admissions for these conditions remained relatively stable over the same time period.
- The rate of emergency admissions increased for falls, cellulitis, urinary tract infections and COPD, but decreased for angina and non-specific chest pain.
Emergency admissions for children with chronic conditions
Asthma
- Between 2008/09 and 2017/18, the rate of emergency admissions for asthma in children and young people aged 0 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 2017/18, 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 2.5 times as high as the rate in young people aged 15 to 24.
Diabetes
- The rates of emergency admissions for type 1 diabetes have been stable or have decreased for younger children aged 0 to 14.
- There has been a striking increase in emergency admissions for diabetes in young people aged 20 to 24. 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 reduced over time for children and young people. Young children aged 0 to 4 have the highest emergency admission rate for epilepsy, at 88 per 100,000 population in 2017/18.
Cancer screening
- Breast screening coverage in England increased from 64% in 2002 to 77% in 2009, where it remained stable until 2012 when it gradually began to decrease. In 2018, breast screening coverage was 75%.
- Cervical screening coverage for the total target age group (25 to 64 years) fell from 76% in 2011 to 71% in 2018.
- Bowel screening coverage in England increased from 35% in 2009/10 to 60% in 2017/18.
Antibiotic prescribing
- In England, the total consumption of antibiotics in primary and secondary care declined by 4.5%, from 22 Defined Daily Doses (DDDs) per 1,000 inhabitants per day in 2013 to 21 DDDs per 1,000 inhabitants per day in 2017.
- While most antibiotic prescribing occurs in general practice (72.4% of total prescribing in 2017), consumption in this setting has declined over time (-9.2%).
* Note that these results from the 2018 and 2019 GP Patient Surveys 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.