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1. Overview

The 2002 Survey of General Practice repeats a survey among patients of general practice carried out in 1998. The key findings of the 2002 survey indicate that, in the great majority of aspects of primary care, the situation, as reported by patients, is largely unchanged from that reported in 1998.

Reported level of use of GP services in the last 12 months was slightly increased; visiting the doctor from 81% to 82% and visiting the practice nurse from 52% to 55%. Reports of out of hours calls (13% of those registered with a GP) and referrals of patients to a hospital doctor (36%) have remained at the same levels.

The views held by patients about their GPs were generally very favourable, as was also the case in 1998. The vast majority of respondents (around 90%) had positive views of GPs' skills, knowledge, attitude and ability to communicate as well as the amount of time that GPs spent with them. Views about nurses were even more positive.

In a few aspects, however, patients' views have become more critical over the past four years. These mainly relate to reports of longer waiting times - waiting for an appointment with your own GP, waiting for an out of hours visit from a doctor, waiting to see a hospital doctor. There is also some indication that patients believe making contact with the surgery is more difficult than it was and that patients were less satisfied with the response they get to out of hours calls.

The 1998 survey report described in detail differences in patient experiences between population sub-groups (sex, age, social class and ethnic groups). In most respects, these differences are still apparent at similar levels in 2002, and are not repeated in this report. Patients with less favourable views were younger people, those living in London and those from minority ethnic groups. As before there were very few differences in views between patients from different social classes.

However, differences between ethnic groups appear to have widened in some respects over the past four years. In 1998, White respondents tended to have the most favourable views or more positive experiences, South Asian respondents tended to have the most negative experiences, and Black respondents tended to fall between these two groups. By 2002, the differences between White and South Asian respondents had increased in the following areas: having prompt and convenient access to GPs (waiting times, difficulties with staff and convenience of surgery times); how patients said they were treated by GPs during physical examinations; whether respondents felt GPs listened to them; and whether respondents felt like making a complaint.

2. Contacting the surgery

The vast majority of the population see a GP in any one year. Eighty-two per cent had seen a doctor at their GP surgery on their own behalf in the last twelve months, an increase of 1% from 1998. Among older patients (those aged 55 or over) the increase was 3% (from 84% to 87%).

3. Prompt and convenient access

Reported waiting times for a GP appointment were longer in 2002 than in 1998. In 1998, 63% of patients said that they usually had to wait two or more days for an appointment, and this increased to 72% in 2002 (a 9% increase). The increase was slightly greater among South Asians. Twenty-five per cent of patients had to wait 4 or more days - the same proportion as in 1998.

There was an increase in the proportion of patients who reported that their last appointment had not been on the day that they wanted (34% in 1998, 39% in 2002) and in the proportion who felt that they should have been seen sooner (19% in 1998, 23% in 2002). These increases were greatest among Black Caribbean and South Asian respondents.

Sixteen percent of respondents said that they had put off going to see their GP at least once in the past 12 months because of inconvenient surgery hours - an increase from 15% in 1998. In 2002, respondents were also more likely to say that someone at the GP surgery had made it difficult for them to see the GP urgently - 19% compared with 17% in 1998. These increases were both greater among South Asian respondents.

Twenty-one per cent said that on at least one occasion in the last 12 months the surgery receptionist had made it difficult for them to see or talk to the doctor, an increase of 2% from 1998. The increase was greater among South Asians.

The great majority of respondents reported surgery receptionists to be helpful. The overall proportion who did not think receptionists were helpful had decreased slightly from 23% to 22%, but had increased among South Asians.

The proportion of respondents who said that they could not always - or even on most occasions - get through to the surgery on the telephone at the first attempt, has increased since the last survey - from 39% to 42%, and increased by a greater amount among South Asian respondents.

4. Respect and dignity

Ninety-five per cent of patients felt their GP treated them as they would wish all or most of the time. There was an improvement in how patients felt they were treated during physical examinations with 82% saying the GP was caring all the time during physical exams, up from 80%. This improvement was not reflected among South Asians.

5. Confidence in clinical skills

Patients' views of their GP's general medical knowledge were very favourable and the same as in 1998. Ninety per cent or more felt that GPs actions had been appropriate on their last visit, or that the GP knew the best treatment most of the time or always, or made the right diagnosis most of the time or always. Eighty-three per cent felt that the GP generally knew about their medical history and the same proportion felt that the GP knew enough about their condition or treatment on the last visit.

6. Involvement and choice

Twenty-two per cent reported that their GP spent 5 or less minutes with them at their last consultation compared with 24% in 1998. The great majority of patients were satisfied with the length of time the GP spent with them at their last consultation. Only 14% (compared with 13% in 1998) said that the time should have been longer.

Eighty-nine per cent reported that their GP took their opinions seriously most of the time or always. Ninety-one per cent reported that their GP listened to them most of the time or always, an improvement from 1998, and there was an improvement among all ethnic groups except South Asians.

Thirteen percent of patients said that they had felt like making a complaint about someone at the surgery (doctor, nurse, receptionist or other staff) at least once in the past 12 months, a slight increase from 12% in 1998. Only one percent of patients actually made a complaint.

7. Information and education

As in the earlier survey, nearly nine in ten of respondents answered favourably about the amount of information given to them by the GP, whether GPs explanations were clear, and about whether they felt able to ask questions. Among those who did ask questions, around one-fifth felt that not all their questions were answered.

8. Environment and facilities

Eighteen percent of patients said that they were not always able to get a seat in the surgery waiting room. Only 12% of patients said that, in their opinion, it would be difficult for patients with disabilities to move around the surgery waiting room.

9. GP preference

There was a small increase from 22% to 23% in the proportion of patients who were not happy to consult at least one GP in their practice. A substantial minority (38%) were not able to see a GP of their own sex every time that they had wanted to, a small increase from 37% in 1998. Slightly fewer respondents (30%) were not able to see a GP from their own ethnic group every time that they had wanted to, although this was also an increase from 1998 (28%).

10. Nurses

The proportion of patients who had seen a nurse in the last 12 months increased from 52% in 1998 to 55% in 2002.

As in 1998, patients experience of nurses was very positive: 88% felt that the nurse had answered all their questions (a slight decrease from 89% in 1998); 92% felt the nurse knew enough about their condition; and virtually all felt that nurses actions were appropriate (98%), or easy to understand (97%), or that they had been treated with dignity and respect (99%).

11. Out of hours care

Thirteen percent of those registered with a GP had made on their own behalf an out-of-hours telephone call either to their GP surgery or to a central out-of-hours number within the past 12 months, compared with 14% in 1998. The likelihood of having had a home visit as a result of the call had decreased since 1998 from 21% to 15% for visits from patients' own GP and from 26% to 18% for another GP.

In addition to home visits being less likely in 2002, respondents felt it was more difficult to persuade a doctor to come and see them (20% compared with 16% in 1998), and they were more likely to have to wait for an hour or more for the doctor to arrive (55% compared with 47%). Patients were less likely to report that the out of hours response that they had received was correct (73% compared with 77%).

12. Referrals

Over one third (36%) of patients had been referred by their GP to a hospital specialist during the last twelve months compared with 35% in 1998. One in ten of these patients (11%) considered that they should have been referred earlier.

Longer waiting times were reported in 2002 than in 1998 for the time between being referred by a GP and the first time that patients were seen by a hospital doctor. Fifty-eight per cent of patients said that they had to wait more than a month compared with 53% saying this in 1998.

Respondents were slightly more negative in 2002 than in 1998 about the levels of communication between GPs and specialists about their referral. The proportion who reported that the hospital doctor or specialist did not know enough about their condition increased from 12% to 13%, and there was an increase in the proportion who felt that their GP had not been informed about their visit to the specialist from 15% to 17%.