The recent annual public satisfaction ratings for the NHS were probably the last thing GP practices needed to hear after such a tough two years – especially coming, as they did, just as practices were going back into QOF, enhanced services and dealing with rising numbers of Covid cases.

The document from the latest British Social Attitudes survey (carried out for think tanks The King’s Fund and the Nuffield Trust) made for bleak reading. It contained responses from more than 3,000 people surveyed in September and October last year in England, Scotland and Wales.

It showed that in 2021, satisfaction with GP services fell significantly from 68% satisfied the year before, to just 38%. This was the lowest level recorded since the survey began in 1983.

Satisfaction fell for other health services too, but the report’s sobering message was: “Satisfaction with GP services is now the lowest of any NHS service with the exception of dentistry. It had previously been the highest-rated service every single year until 2018, when it was overtaken by satisfaction with outpatient services.”

The authors of the report have theories as to why this may have happened: “Although the public have recognised the unprecedented nature of the pandemic and largely accepted the necessity for health and care services to reprioritise patients, restrict access and delay care for millions, it seems likely that this understanding and the support the public had shown during the early period of the pandemic has been overtaken by concerns people have about the impact these very actions are continuing to have.”

The situation was probably not helped by the government’s comments last year that appeared to criticise primary care and the difficulties in accessing appointments.

Craig Lee, Practice Operations Manager at a practice in Accrington, says: “That created a narrative and perhaps people misconstrued that to mean that general practice had been shut during the pandemic, which was not the case!

“We’ve been really busy over the last couple of years and a lot of us have seen activity levels actually increase with things like telephone triage meaning we’ve seen even more patients, even if not physically.”

Why patients are frustrated

Unsurprisingly, practice managers are disappointed with the feedback but understand why patients are feeling disgruntled.

Bex Cottey, Business Manager at a GP practice near Doncaster, says: “I think there’s a mismatch between what can realistically be delivered within primary care now and patient expectation… We seem to have this great reminiscence and think we can go back to how it was, but we’re thinking back to days that never really existed when you could just drop in and see your doctor that day and there was no great queue.”

Nicola Davies, a Practice Manager in Cornwall and co-founder of the Institute for General Practice Management (IGPM), comments: “I think this is the hangover from Covid and there are mixed messages coming out. On the one hand, you have the media showing that things have changed and we’re no longer wearing masks so everything’s fine, and then a patient gets ‘hit’ with what they perceive to be barriers to accessing healthcare.

“Demand now is actually higher than it was pre-Covid and the number of appointment requests that we’re having is higher than before.”

How to turn around that frown

Despite the gloom, according to Craig Lee, there are things that can be done to address the situation.

“We need to make sure we get our communication right. We’ve met with our PPG [Patient Participation Group] throughout the pandemic virtually and tried to make sure those communication channels are open. We’ve made sure we’ve updated our website regularly, so if, for example, staff have been off ill, we’ve communicated that to manage expectations.

“We’ve made sure we’ve been clear with patients about what we’re doing… and how many appointments we have… and how that compares to last year.

“Is it time for practices take a step back and look at their own staffing profile and staffing mix? Do they need to recruit some extra people, and are they making use of the ARRS [Additional Roles Reimbursement Scheme] because some people are doing better with that than others.

“Practices could consider becoming a training practice. We’ve always been a training practice and the last two doctors we’ve recruited have been trainees here.”

Positive messaging

It seems that sending out the right messages to the public and keeping them in the loop is an essential part of building their feeling of satisfaction with primary care.

Cottey says: “We need central messaging because we need people to understand what can be expected and what’s reasonable.

“I think it comes down to educating and it’s going to be a long drip feed. It can’t be a quick TV campaign. There needs to be a consistent message across the whole of primary care.”

Davies agrees, adding: “We need the government to be saying here are the statistics. We currently have more people in hospital in Cornwall with Covid than we did in February of last year. The reality is that Covid has not gone away, but people are fed up.

“It’s hard for us to stay optimistic, but I try and put on my surgery website all the positive stuff that’s happening – that patient activities have resumed, that they can go out and do walks, and do painting and all of the things that my patient group does locally for my community, and we’re looking at a new weight management service so people can get fit for the summer.”

Collaborative working

Lee’s practice has also spoken to other local practices to see if they can work together to tackle some of these problems – e.g., practices sharing some back-office functions such as HR.

“Tier 2 sponsorship is something we’ve done in the last 12 months and with a couple of people we’ve recruited that’s been very useful,” he suggests.

“We’ve also worked with the local press. About 12 months ago, we had a really out-of-date phone system that was struggling to cope with the demand and patients were unhappy with it. We were honest about the problems. It was a system supplied and funded by the CCG. We wrote a series of open letters to patients that we published on the website, left copies at reception, and put in the local papers explaining that ‘these are the problems; this is what we’re doing’. We ended up speaking to our PPG and took their feedback on board and got our own telephony system. So, we were able to run that positive news story.”

Perhaps efforts like this might just turn the tide of public opinion and next year’s public survey will tell a very different story.