Background
In England, more than 15 million people (over a quarter of the population) have a long-term health condition, or a health problem that cannot be cured but can be controlled with medication or other therapies. Over the next ten years this figure is expected to increase, especially among those living with multiple conditions. Care of people with long-term conditions accounts for about 70% of the money we spend on health and social care in England.
The NHS aims to support people with long-term conditions to be as independent and healthy as possible, preventing complications and the need to go into hospital. Providing timely and effective primary and community care for selected long-term conditions (known as ambulatory care sensitive conditions) can help reduce avoidable emergency admissions to hospital.
In this indicator we look at the experience of support received by patients with long-term conditions. We also assess the quality of care and treatment for chronic obstructive pulmonary disease (COPD) and diabetes in particular.
Support for patients with long term conditions
Until 2017, GP Patient Survey respondents were asked, "In the last 6 months, have you had enough support from local services or organisations to help you to manage your long-term health condition(s)?". Between 2012 and 2017, the proportion of respondents who answered “Yes, definitely” decreased from 54% to 51%, and those that answered “No” increased from 15% to 17%. This indicates that the NHS might be struggling to keep up with the demand for services that provide support for people with long-term conditions.
The question was changed in the 2018 GP Patient Survey to ask, "In the last 12 months, have you had enough support from local services or organisations to help you to manage your condition (or conditions)?”. Note that these results are not directly comparable with those from previous surveys. Please see ‘About this data’ for more information.
Between 2018 and 2023, there has been a visible drop in perception of support, particularly after 2020. The percentage of respondents who stated that they definitely had enough support in the last 12 months decreased from 43% in 2018 to 28% in 2023. In the same time frame, the percentage who reported that they had not received enough support increased from 21% to 35%. Those who responded “I haven't needed support” and “Don't know/Can't say” have been excluded for comparison purposes.
Support for patients with long term conditions by age
There is variation between different age groups in how supported patients feel to manage their long-term health condition(s). Results from the 2023 GP Patient Survey show that fewer patients in the younger age groups felt supported to manage their condition compared with the older age groups. Only 58% of respondents aged 16 to 24 felt supported, compared with 75% of respondents aged 75 to 84. Those who responded, “I haven’t needed support” and “Don’t know/Can’t say” have been excluded for comparison purposes.
Support for patients with long term conditions by deprivation
There is also an association between the level of deprivation and how supported people feel to manage their long-term health condition(s). Results from the 2023 GP Patient Survey show that a smaller proportion of people from the most deprived areas (23%) said that they definitely felt supported compared with people from the least deprived areas (33%), showing a strong correlation between feeling supported and socio-economic factors that determine categories of deprivation.
Care provided for COPD
Chronic obstructive pulmonary disease (COPD) is a group of common lung diseases, including chronic bronchitis and emphysema, that makes breathing progressively more difficult. Timely care for COPD is important to reduce the damage suffered by the lungs and enable individuals to live a more active life. The provision of timely care for patients with COPD exacerbations has improved over time. The percentage of admissions that were reviewed by a member of the respiratory team increased from 77% in 2014 to 87% in 2018-19; in 2019-20, 88% of admissions were reviewed. There was also an increase in the proportion of admissions reviewed within 24 hours, from 49% in 2014 to 61% in 2022-23.
The recording of key clinical information showed mixed results. In 2022-23, 99% of admissions were prescribed oxygen but only 46% of admissions had a spirometry result available. Further to this, the most recent audit shows that, of the admitted patients who were current smokers, only 59% were referred to a behavioural change intervention and/or prescribed smoking cessation pharmacotherapy during their admission.
Only 10% of admissions received acute treatment with non-invasive ventilation (NIV) in 2019-20. Of those who received it, 25% received NIV within two hours of arrival in 2019-20. This decreased to 18% in 2022-23. The audit notes that patients whose health deteriorated later in the admission and were appropriately managed with late NIV cannot be distinguished from those that presented with acidosis and received inappropriate late NIV.
In terms of the discharge process, only 27% of admissions received a discharge bundle in 2021-22, a dramatic decrease from 76% in 2019-20. Data from 2022-23 is unavailable.
Treatment provided for diabetes
Diabetes is a condition where the amount of glucose in your blood is too high. There are two main types of diabetes: Type 1 diabetes (when the body is unable to produce any insulin) and Type 2 diabetes (when the body is unable to produce enough insulin or the body's cells don't respond to insulin). While around 90% of diabetes cases are Type 1, Type 2 is increasing in prevalence.
For patients over 12 years of age, guidance published by NICE states that three targets must be met for comprehensive diabetic treatment to be achieved. The benefit of each of the three treatment targets is listed below:
- The HbA1c target (≤58 mmol/mol) reduces the risk of all diabetic complications.
- The blood pressure target (≤140/80) reduces the risk of cardiovascular complications and reduces the progression of eye and kidney disease.
- The statin target prevents cardiovascular disease.
Between 2012-13 and 2023-24, the proportion of patients achieving all three treatment targets in England improved for Type 1 diabetes from 16% to 24%. However, for Type 2, it decreased slightly from 38% to 37%. Nonetheless, in 2023-24, the proportion meeting all three treatment targets for Type 2 diabetes exceeded the figure for Type 1 diabetes by 13 percentage points.
Achievement of the blood pressure and statin target is roughly the same for Type 1 and Type 2 diabetes, but glucose control is worse in patients with Type 1 diabetes. In 2023-24, 64% of patients with Type 2 diabetes achieved the glucose control target, compared with only 39% of patients with Type 1 diabetes.
About this data
In 2018, two key changes were made to the GP Patient Survey:
- The content of the questionnaire was changed significantly to reflect changes in the delivery of primary care services in England.
- The sample frame was extended to include 16-17-year-olds for the first time to improve the inclusivity of the survey.
Analyses were carried out by Ipsos MORI to measure the impact of these changes on the comparability of trend data. These analyses found that trend data was subject to both context effects as a result of changes to the questionnaire and the inclusion of 16-17-year-olds. As a result, the data presented here from the GP Patient Surveys carried out from 2018 onwards are not comparable with results from previous surveys.
The data was weighted to adjust for differences between all patients at a GP surgery and the subset of patients who actually completed the questionnaire.
In 2020, fieldwork for the GP Patient Survey took place between 2 January and 6 April 2020. This means that some responses were collected after the Covid-19 outbreak began in England. Analysis was conducted to understand whether the pandemic had an impact on results. The analysis found that, as only 1.2% of responses were received after lockdown measures were implemented, the results of the survey and validity of comparisons with previous surveys were not impacted by the pandemic.
For more detailed information, please see the GP Patient Survey - Technical Annex.
The COPD indicator uses data from the National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme. It is a continuous audit, which captures the process and clinical outcomes of treatment in patients admitted to hospital in England, Wales and Scotland with COPD exacerbations. In spring 2020, NHS services were instructed to prioritise Covid-19 activity and collect routine data only if they had the capacity to do so. Due to this, data from 2019-20 has a relatively small cohort size and cannot be compared with previous years. Data for 2020-21 is unavailable, reasons for which have not been disclosed.
For the 2019-20 report, NACAP and HQIP decided not to publish Covid-19 impacted data. The 2019-20 report only contains data collected between 1 October 2019 and 29 February 2020 and is not comparable with previous years’ data as a result. For 2017-18, continuous data collection began on 1 February 2017 in England and Wales. All hospitals in England, Scotland and Wales that admit patients with acute exacerbations of COPD were eligible to participate in the audit. It should be noted that in 2017, data was extracted prior to a full year of data collection in order for the report to be published in line with the National COPD Audit Programme’s contract end date. Therefore, data for 2017 presents the results for patients discharged between 1 February and 13 September 2017. Data for 2017-18 presents the results of patients discharged between 14 September 2017 and 30 September 2018 and data for 2018-19 presents the results of patients discharged between 1 October 2018 and 30 September 2019. For more information, please see the Royal College of Physicians’ website.
The diabetes indicator uses data from the National Diabetes Audit (NDA) commissioned by the Healthcare Quality Improvement Partnership (HQIP), funded by NHS England, and managed by NHS England in partnership with Diabetes UK. The NDA provides a comprehensive view of diabetes care in England and Wales and measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards. The audit reports on a fifteen-month period, so data for 2019-20 covers January 2019 to March 2020.
There was a change in the treatment targets used, from HbA1c, blood pressure and cholesterol (up to 2016-17) to HbA1c, blood pressure and statin prescription (in 2017-18). Hence, the indicator only displays data on statin prescription from 2017-18 onwards.