Why has the Kings Fund lumped NHS Scotland together with the others to suggest a dramatic fall in satisfaction with GPs?

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Here’s how the Guardian reported on the recent Kings Fund research on satisfaction levels with GPs.

‘Only 65% of the representative sample of 3,004 people in England, Scotland and Wales questioned last autumn were satisfied with GP services, the lowest percentage since records began in 1983. That is sharply down on the 80% satisfaction rating seen as recently as 2009. Satisfaction fell by 7% between 2016 and 2017 alone in what experts said reflected public frustration at the increasing difficulty in getting a timely GP appointment.’

https://www.theguardian.com/society/2018/feb/28/satisfaction-with-gps-at-lowest-level-for-30-years-survey-finds

I emailed to request a breakdown of English, N Ireland, Scottish and Welsh responses so that I could make a comparison justified by the separate management of the four. I had been able to do so with the Commonwealth Foundation of New York in 2015 which had revealed Scottish GPs to be significantly more satisfied and less-stressed than those elsewhere. My full report is here:

Scottish GPs: Most satisfied and least stressed in the UK and possibly the world

However, the Nuffield trust response was:

‘There isn’t really a single source of data that compares the four different health systems.  The most regular report I think would be by The European Observatory on Health Systems and Policies.  They publish the Health Systems in Transitions (HiT) report for a number of countries.  They are published roughly every five years or so, the last United Kingdom HiT was published in 2015 and compared the four nations’ health systems.

Well, clearly a 2015 report is of no use to us but the impossibility of easily extracting the Scottish responses seems surprising when the Commonwealth Foundation had no such difficulty.

I don’t want to seem paranoid but given the nature of responsibility of the four NHS areas, why didn’t they organise the data so that comparisons could be made? One conclusion would be that they have been pressurised not to allow such comparison.

So, we’re left with speculation and I speculate that the Scottish patient satisfaction level will be higher because we have more GPs per head of population, that our GPs have been offered a superior contract and that, at least in 2015, they reported themselves to be relatively free of stress or undue workload. See these for details:

‘Scotland has more GPs per head of population than any other part of the UK, newly released statistics show’

Already the best staffed and least stressed in the UK, Scottish GPs to get better contracts

New Scottish GP contract rated far superior, by BMA, to English equivalent as Scottish GP numbers hold steady and NHS England loses 1 000 in one year!

 

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7 thoughts on “Why has the Kings Fund lumped NHS Scotland together with the others to suggest a dramatic fall in satisfaction with GPs?

  1. Ann Forbes February 28, 2018 / 5:43 pm

    The King’s Fund report was broadcast on BBC TV either last night or today !

    Family & Education
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    Health
    Satisfaction with GP services at record low
    By Ian Westbrook
    Health reporter, BBC News
    28 February 2018
    169 comments Share this with Facebook Share this with Twitter Share this with Messenger Share this with Email Share

    Media captionGovernment must give more money to healthcare, says professor
    Public satisfaction with GP services has fallen to its lowest level since records began in 1983, according to the annual British Social Attitudes survey.
    Satisfaction dropped seven percentage points to 65% in the 2017 study, making it the first time general practice has not been the highest-rated NHS service.
    The study showed people were happy with the care given by GPs, but were unhappy about things like waiting times.
    Public satisfaction with the NHS fell six percentage points from 2016.
    Hugh Pym analysis: How unhappy is the public with NHS?
    Only 57% of people were happy with the service – the lowest level since 2011 – while dissatisfaction has risen to 29% – the highest level in a decade.
    Bar chart showing reasons for dissatisfaction with the NHS
    The survey was conducted by the National Centre for Social Research (NatCen) and analysed by the Nuffield Trust and the King’s Fund think tanks.
    A nationally representative sample of 3,004 people in England, Scotland and Wales were asked about their overall satisfaction with the NHS and 1,002 of them were also quizzed about their satisfaction with individual NHS services.
    The main reasons for satisfaction and dissatisfaction with the overall service were:
    Satisfaction –
    quality of care
    free at the point of use
    attitudes and behaviour of NHS staff
    range of services and treatments available
    Dissatisfaction –
    staff shortages
    long waiting times
    lack of funding
    government reforms
    “The public used to put GPs on a pedestal,” said Ruth Robertson, fellow at the King’s Fund. “But since 2009, when there was an 80% satisfaction rating, it has been steadily declining.
    “It shows the impact of the huge pressure on GPs and the public is responding to that.”
    NHS Tracker: Check targets in your area
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    Missed NHS targets spell trouble
    However, Ms Robertson was keen to stress that the NHS was still highly valued by the public.
    “More people are satisfied with the NHS than are dissatisfied,” she said. “They showed really strong support for the core value principles of the NHS.
    “I think this shows that it is not falling out of favour, but people are worried about the NHS and they are worried about funding and staffing shortages.”
    The age group which was most satisfied with GPs was people aged over 65 and Ms Robertson added: “This is because they see GPs more often so build up a stronger personal relationship with them.”
    A GP sits at his deskImage copyrightGETTY IMAGES
    Prof John Appleby, chief economist and director of research at the Nuffield Trust, told the BBC: “These results should make the government sit up and take notice.
    “If they want to see satisfaction rise, my suggestion is they should think seriously now about more money for healthcare over the next few years.
    “The public are concerned about headline measures and things they really notice like waiting times.
    “We have seen over the last 18 months or two years increasingly hospitals miss their targets in terms of their A&E waiting times and their inpatient waiting times.
    “We know that people are increasingly dissatisfied with their access to getting GP appointments and so on, so there is clearly something to be done.
    “It’s not just about money to fix these problems but these are the things that the public notice and they care about, so it’s something that the government should also notice and care about.”
    You may also be interested in:
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    An Ipsos/Mori poll published at the start of February showed that nearly half the public felt the biggest issue facing Britain was the NHS (48%), more than those with concerns about Brexit (46%).
    Prof Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “This is extremely distressing news for hard-pressed GPs and their teams who are working flat out to do the very best they can for their patients in increasingly difficult circumstances.
    “But while we are very disappointed in these figures, they are hardly surprising as what we are seeing now is symptomatic of the inevitable effects of a decade of underinvestment in our family doctor service – and just not having enough GPs in the system to meet demand.
    “Our service is the lifeblood of the NHS – we manage risk and uncertainty as well as considering all aspects of our patients’ lives when delivering care.
    “Without general practice, other NHS services would crumble, but we urgently need more support, including more GPs, if we are to deliver the safe and effective care that our patients need and have come to rely on.”
    A Department of Health and Social Care spokesman said: “Just last year, the NHS was rated as the best and safest health system in the world by independent experts and, as this report itself points out, the majority of patients are satisfied with the NHS.”
    Shadow health secretary Jonathan Ashworth said: “This report exposes widespread public dissatisfaction with NHS performance under this government, as years of overstretched budgets take their toll on frontline services.”
    View comments169
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  2. Ludo Thierry February 28, 2018 / 6:51 pm

    Hi Ann – I suspect something strange happened to your post! (lost in translation!).

    John – you wonder whether there might have been (political) ‘leaning on’ King’s Fund? – I certainly hope that was the case – otherwise we can only assume total incompetence (and I don’t actually believe that the authors are as incompetent as that).

    The ‘survey’ isn’t by The King’s Fund as such. They and Nuffield Trust have purchased questions on the British Social Attitudes Survey (longstanding annual survey). The BSA describe their process thus: See below:

    Since 1983, NatCen Social Research’s British Social Attitudes (BSA) survey has asked members of the public about their views on, and feelings towards, the NHS and health and care issues generally. The latest survey was carried out between July and October 2017 and asked a nationally representative sample of 3,004 adults in England, Scotland and Wales about their satisfaction with the NHS overall, and 1,002 people about their satisfaction with individual NHS and social care services.

    Also: Footnotes
    1. The 2017 BSA survey questions on satisfaction with the NHS reported here were jointly sponsored by the Nuffield Trust and The King’s Fund.

    (So – no info about how many of the respondents were located in Scotland. Even more worryingly – apparently no conception regarding the pointlessness of asking a ‘general’ question when the respondents are giving their individual opinions regarding the 4 ‘separate’ NHS Services across the various component parts of the UK.)

    NOTE ALSO – They seem to be ‘missing’ Northern Ireland respondents entirely (none mentioned) – which is very sensible as they have their own structure – so why lump the other 3 separate structures (Scotland, wales, England) together as one single entity???).

    The authors even quote a different survey which looks at NHS England specifically: See below:

    ‘NHS England’s national GP patient survey (which covers England, rather than Britain) includes a similar question that provides a useful comparator for these results (‘Overall, how would you describe your experience of your GP surgery?’) . In a similar way to the BSA satisfaction measure, the proportion of patients who describe their experience as ‘good’ has steadily decreased
    in recent years, from 89% in July 2012 to 85% in July 2017. The proportion describing their overall experience of making an appointment as ‘good’ also decreased from 79% to 73% over the same period.’

    The BSA explain their methodology (see below – but seem blissfully unaware of the pointlessness of it all given the separate NHS structures they are enquiring into – and treating as if the 4 structures were a single entity – this is surely bonkers?):

    Methodology
    Sample and approach
    The 2017 survey consisted of 3,988 interviews with a representative sample of adults in England, Scotland and Wales. Addresses are selected at random and visited by one of NatCen Social Research’s interviewers. After selecting (again at random) one adult (aged 18 and over) at the address, the interviewer carries out an hour-long interview. The participant answers most questions by selecting an answer from a set of cards.
    The sample size for the overall NHS satisfaction question reported here was 3,004 in 2017; for questions about satisfaction with other NHS services the sample size was 1,002. The data is weighted to correct for the unequal probabilities of selection, and for biases caused by differential non-response. The weighted sample is calibrated to match the population in terms of age,sex and region. The margin of error in 2017 for the health care questions was around +/–1.4 to 3.7 percentage points.
    The majority of fieldwork for the 2017 survey was conducted between July and October, with a small number of interviews taking place in November.

    If one isn’t to despair at the idiocy of such an ‘academic’ project one has to fervently hope that, indeed, nefarious political interference was brought to bear in its commissioning.

    Liked by 2 people

  3. Ann Forbes March 1, 2018 / 10:22 am

    Hi Ludo – thanks , you’re right !
    This is what should have appeared .

    News BBC News Navigation
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    Family & Education
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    Health
    Satisfaction with GP services at record low
    By Ian Westbrook
    Health reporter, BBC News
    28 February 2018
    203 comments Share this with Facebook Share this with Twitter Share this with Messenger Share this with Email Share

    Media captionGovernment must give more money to healthcare, says professor
    Public satisfaction with GP services has fallen to its lowest level since records began in 1983, according to the annual British Social Attitudes survey.
    Satisfaction dropped seven percentage points to 65% in the 2017 study, making it the first time general practice has not been the highest-rated NHS service.
    The study showed people were happy with the care given by GPs, but were unhappy about things like waiting times.
    Public satisfaction with the NHS fell six percentage points from 2016.
    Hugh Pym analysis: How unhappy is the public with NHS?
    Only 57% of people were happy with the service – the lowest level since 2011 – while dissatisfaction has risen to 29% – the highest level in a decade.
    Bar chart showing reasons for dissatisfaction with the NHS
    The survey was conducted by the National Centre for Social Research (NatCen) and analysed by the Nuffield Trust and the King’s Fund think tanks.
    A nationally representative sample of 3,004 people in England, Scotland and Wales were asked about their overall satisfaction with the NHS and 1,002 of them were also quizzed about their satisfaction with individual NHS services.
    The main reasons for satisfaction and dissatisfaction with the overall service were:
    Satisfaction –
    quality of care
    free at the point of use
    attitudes and behaviour of NHS staff
    range of services and treatments available
    Dissatisfaction –
    staff shortages
    long waiting times
    lack of funding
    government reforms
    “The public used to put GPs on a pedestal,” said Ruth Robertson, fellow at the King’s Fund. “But since 2009, when there was an 80% satisfaction rating, it has been steadily declining.
    “It shows the impact of the huge pressure on GPs and the public is responding to that.”
    NHS Tracker: Check targets in your area
    NHS ‘dangerously’ short of 100,000 staff
    Did the NHS avert disaster this winter?
    Missed NHS targets spell trouble
    However, Ms Robertson was keen to stress that the NHS was still highly valued by the public.
    “More people are satisfied with the NHS than are dissatisfied,” she said. “They showed really strong support for the core value principles of the NHS.
    “I think this shows that it is not falling out of favour, but people are worried about the NHS and they are worried about funding and staffing shortages.”
    The age group which was most satisfied with GPs was people aged over 65 and Ms Robertson added: “This is because they see GPs more often so build up a stronger personal relationship with them.”
    A GP sits at his deskImage copyrightGETTY IMAGES
    Prof John Appleby, chief economist and director of research at the Nuffield Trust, told the BBC: “These results should make the government sit up and take notice.
    “If they want to see satisfaction rise, my suggestion is they should think seriously now about more money for healthcare over the next few years.
    “The public are concerned about headline measures and things they really notice like waiting times.
    “We have seen over the last 18 months or two years increasingly hospitals miss their targets in terms of their A&E waiting times and their inpatient waiting times.
    “We know that people are increasingly dissatisfied with their access to getting GP appointments and so on, so there is clearly something to be done.
    “It’s not just about money to fix these problems but these are the things that the public notice and they care about, so it’s something that the government should also notice and care about.”
    You may also be interested in:
    Rare photographs that changed lives
    Landlords who say ‘no DSS’ flout the law
    How cold is it where you are?
    An Ipsos/Mori poll published at the start of February showed that nearly half the public felt the biggest issue facing Britain was the NHS (48%), more than those with concerns about Brexit (46%).
    Prof Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “This is extremely distressing news for hard-pressed GPs and their teams who are working flat out to do the very best they can for their patients in increasingly difficult circumstances.
    “But while we are very disappointed in these figures, they are hardly surprising as what we are seeing now is symptomatic of the inevitable effects of a decade of underinvestment in our family doctor service – and just not having enough GPs in the system to meet demand.
    “Our service is the lifeblood of the NHS – we manage risk and uncertainty as well as considering all aspects of our patients’ lives when delivering care.
    “Without general practice, other NHS services would crumble, but we urgently need more support, including more GPs, if we are to deliver the safe and effective care that our patients need and have come to rely on.”
    A Department of Health and Social Care spokesman said: “Just last year, the NHS was rated as the best and safest health system in the world by independent experts and, as this report itself points out, the majority of patients are satisfied with the NHS.”
    Shadow health secretary Jonathan Ashworth said: “This report exposes widespread public dissatisfaction with NHS performance under this government, as years of overstretched budgets take their toll on frontline services.”

    Like

  4. stewartb March 1, 2018 / 7:57 pm

    Hi John, have you looked at the Scottish GP stats here? (http://www.gov.scot/Topics/Statistics/Browse/Health/GPPatientExperienceSurvey/HACE2015-16 )

    For example, at http://www.hace15.quality-health.co.uk/reports/health-board-reports/2472-nhs-greater-glasgow-clyde-pdf/file you find this:

    “Rating of overall care provided by the GP practice” from survey data in Greater Glasgow and Clyde area = 89% (2% higher than Scotland average)

    An update is due to be published in later April 2018. (See: http://www.gov.scot/Topics/Statistics/Browse/Health/GPPatientExperienceSurvey )

    Like

    • johnrobertson834 March 2, 2018 / 3:56 pm

      Brilliant Stewart. Many thanks. I saw the update is coming in April and will prob use that.

      Like

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