Primary care

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


Indicator update

Published: 23/09/2021

Primary care acts as the ‘front door’ of the health system, as a patient’s first and main point of contact. Ensuring access to high quality primary care can make health systems more efficient and improve patient experience. It encompasses a wide range of services, including general practice, pharmacy, optometry and dentistry.

This month, we’ve updated our indicators on the quality of primary care, largely focusing on general practice. At the start of the coronavirus (Covid-19) pandemic, the number of GP appointments fell by a third but practices are now reporting a high demand for services. There have also been significant changes in how patients access services, with a rapid switch towards online triage systems and remote appointments either by telephone or video.

Our measures highlight changes in access to general practice during the pandemic. Despite the considerable pressure on services, the 2021 GP Patient Survey results indicate that patient experience was maintained or improved for many aspects of care quality. An area for improvement relates to the amount of support from local services or organisations to help patients manage long-term health conditions. For more information on any of our indicators, click the links for more detailed content and analysis.

Access to GP services

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  • At the start of the Covid-19 pandemic, the number of appointments in general practice fell by a third, from 24 million in March 2020 to 16 million in April 2020. 
  • The number of appointments taking place on the same day as booking remained roughly constant during the first wave of the pandemic, while appointments taking place a week or more after booking fell considerably.
  • In July 2021, around 26 million appointments took place in general practice, almost back to pre-pandemic levels.
  • 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 worsened from 81% in 2012 to 65% in 2020, before improving slightly to 68% in 2021.
  • The proportion of patients who ‘always or almost always’ saw or spoke to their preferred GP when they would like to – a measure of continuity of care – decreased from 26% in 2018 to 22% in 2021.

Overall experience of services

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  • The 2021 GP Patient Survey reported that 83% of patients had a good overall experience (‘very good’ or ‘fairly good’) of their GP surgery, a slight improvement from 82% in 2020 (a largely pre-pandemic survey)
  • GP Patient Survey respondents whose last appointment was face-to-face with a clinician were more likely to say that their needs were met during their last appointment. In 2021, 68% said that their needs were ‘definitely’ met, compared to 57% of respondents who had a telephone appointment.
  • The proportion of patients who had a good overall experience of NHS dental services decreased substantially, from 84% in 2020 to 77% in 2021.

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 increased from 68% in 2020 to 72% in 2021.

Do patients feel involved in decisions about their care?

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  • 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 remained constant at 61% for the last three years. In 2021, 7% of respondents were not involved as much as they wanted to be.

NHS Health Check programme

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  • In 2020/21, during the Covid-19 pandemic, the number of NHS Health Checks taken up plummeted to 190,710 (1% of eligible population) with only 488,457 offered (3% of eligible population).*
  • Previously, over 1.2 million health checks were taken up each year.

* Note that the NHS Health Check programme aims to cover the eligible population over a five-year period, and so the number offered is expected to be around 20% of the eligible population.

Antibiotic prescribing

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  • While most antibiotic prescribing occurs in general practice (71% of total prescribing in England in 2019), consumption in this setting has decreased by 16% since 2014.
  • The rate of antibiotic prescribing in primary care in the United Kingdom per 1,000 inhabitants is about average among OECD comparator countries.

GP referrals

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  • In February 2020, the number of GP referrals to consultant-led outpatient services fluctuated around 360,000 referrals per week. From the week starting 9 March 2020, the number of referrals began to fall dramatically, reaching a low of 53,268 in the week starting 13 April.
  • Referrals for routine cases fell by 90%, urgent referrals fell by 76% and two-week wait referrals for suspected cancer fell by 67% during the first wave of the pandemic.
  • Over the summer and autumn of 2020, referrals began to increase again, with falls occurring during bank holidays. By the week starting 23 August 2021, the number of referrals had increased to 325,274.

Supporting patients to manage their long-term condition(s)

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  • Between 2018 and 2021, 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 43% to 37%.
  • Only 69% of patients aged 16 to 24 ‘definitely’ or ‘to some extent’ felt supported to manage their long-term condition in 2021, compared to 80% of respondents aged 75 to 84.

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