The 2023 survey results confirm many of the known challenges facing the NHS across the UK, particularly pressures on general practice and hospital services. They also note that some of these pressures are not unique and exist in other health systems. The UK results suggest that there are areas of strength compared to other countries. This section uncovers some of the survey’s implications, primarily for England, but also for the UK where data allows.
General Practice
On the bright side, the UK remains a country with a high proportion of people (97%) who report seeing a GP regularly, which is considered a fundamental component of primary care. For example, in countries where the proportion of people seeing a GP regularly is low or declining: We or CanadaAs a result, experts worry that health systems will struggle to effectively prevent, diagnose and treat disease early, or manage chronic conditions.
The UK also performs well compared to many countries in the proportion of people who say they can get an appointment on the same or next day (42%). For England, this is broadly consistent with other sources of evidence. GP Activity Data (52% of GP appointments are made on the same day or the day after someone contacts the practice) 2023 GP Patient Survey (It turns out that 44% of patients were seen the same or next day after attempting to schedule an appointment).
Other responses highlight the severity of the pressures on general practice. The UK stands out for the difficulty of getting same-day answers to medical issues. While not every enquiry requires a same-day response, the findings are similar to those of the 2023 GP Patient Survey in England, which suggests patients are having increasing problems contacting practices. For the first time since 2012, More patients More people said it was difficult than easy to contact a practice by phone (and over 80% of patients still book appointments by phone). The difficulties in contacting GP practices are reflected in a recent national survey: Scotland and Wales.
The survey results suggest that pressures on GP practices are felt even after patients have booked an appointment, with the UK tending to score lower than other countries when asked whether GPs spend enough time with patients, explain things in an easy-to-understand way and involve them in decisions about their care and treatment.
The reasons behind these results are well known: GP appointments in England are at record levels, but the number of full-time, fully qualified GPs has been falling since 2015, and the proportion of overall NHS funding going to primary care has also fallen. Government policies Priority has been given to making it easier for people to contact practices (for example by improving phone systems) and to increasing the number of appointments available, particularly by increasing the number of non-GP staff. However, there are concerns that these policies, primarily aimed at increasing the ‘supply’ of appointments, may be at the expense of other important aspects of GP care, such as the importance of continuity of care, which can lead to better outcomes and may be even more important. Efficient In the long run.
Like the 2022 GP survey, this latest survey found that significantly more general practice appointments are made by phone (or video) in the UK than in many other countries. In England, the pandemic led to a rapid switch to virtual GP appointments, with the proportion of face-to-face GP appointments falling to a low of 36% in April 2020. In 2021, the government Urged GP practices are calling for more face-to-face consultations. The proportion of face-to-face consultations has increased compared to virtual consultations, but remains below pre-pandemic levels. GP practices are still Criticized Despite reports in the media of an over-reliance on virtual doctor visits, the survey, consistent with others, found that most people (75%) are comfortable with them. OECD Noting wide variation in the extent to which countries have switched to telehealth during and after the pandemic, they encouraged systematic collection of data on the value and accessibility of telehealth for people in all demographic groups.
Improving access to and quality of general practice is a priority for the UK government, but other countries also face challenges in primary care. Many European countries are facing a shortage of GPs, Policy formulation Increasing the supply of GPs, especially in rural and remote areas. OECD The report also identified weaknesses in each country’s primary care, including poor coordination, inefficient use of staff skills and a lack of focus on prevention, as countries face the challenges of ageing populations, rising chronic diseases and rising costs to their health systems.
Hospital and Specialist Care
The survey confirms known pressures on the UK hospital system. In England: Monthly attendance In July 2024, the number of emergency department visits of all types will be 2.32 million, a 6% increase from 2023, across all four UK countries. Longer waiting times Emergency department visits have been increasing since 2013. The reasons for the increase in emergency department visits are complex. Difficulty in accessing general medical care is probably only one factor (others could include seasonal illnesses, residual effects of COVID-19, and an increase in complex health conditions as the population ages). The survey found that a third of people who used the emergency department thought their problem would have been treated by their GP, but the survey did not ask why their GP was unavailable, for example out of hours. In England, a GP patient survey found that 12.2% of patients who were able to contact their GP but were not offered an appointment, or were unable to make an offered appointment, visited an emergency department instead. In England, Current Policy It aims to increase capacity for urgent and emergency care outside hospitals, including NHS 111.
The UK also stands out for its long waiting times for specialist consultations and elective procedures: while the survey shows that the proportion of people waiting more than four weeks to see a specialist has gradually increased in all countries since 2013, the UK has fallen from being one of the best-performing countries to being the worst (alongside Canada) when it comes to reported waits of more than a year for a specialist or consultant appointment.
Almost without exception, health systems around the world experienced disruptions to hospital services in 2020 and 2021 due to the impact of the pandemic. OECD It is estimated that 2 million fewer elective surgeries were performed in 23 European countries in 2020 than in 2019, with backlogs being common. 2022 Analysis A WHO study of European countries noted that while some health systems have been successful in reducing these backlogs, this has been more difficult in areas with fewer health workers before COVID-19 and less financial space to ramp up supplies.
The UK has spent less per capita on healthcare over the past decade than many comparable countries with shorter waiting times, such as Germany. Canada and Sweden Even before the pandemic, both countries had problems with long waiting times. United KingdomIn England, current policy is: Selective Care Many strategy These measures are similar to those used in other health systems, namely the use of target waiting times, increasing staff supply, and financial incentives for providers. However, historically low levels of investment in NHS buildings and facilities compared to other countries and the lingering impact of COVID-19 may have contributed to slower progress in reducing long waiting times in the UK.
Financial Protection
A comparison of international performance to date has shown that Commonwealth Fundbased on Global Health Policy Survey OECD data shows that affordability is a key feature of a good health system and is an area where the UK ranks higher than other countries. Several yearsanalysis Household Survey Data Research by the WHO in 2018 and 2019 also found that the UK has one of the lowest rates of “impoverishing” and “catastrophic” health spending in Europe.
The survey found that while the UK is still less likely than other countries to say they face cost barriers to accessing doctors, tests and treatments, the proportion has risen slightly in recent years, which is worrying given that healthcare is largely free at the point of use. In England: Health Watch In a survey conducted between October 2022 and March 2023 (a period of higher inflation), 11% of people avoided medical appointments because of the cost of phone or internet connection, and the same number avoided appointments because of travel costs. These challenges likely exacerbate the disadvantages faced by low-income people. Poor Areasthe rate of health problems and medical needs are high, and the number of GPs More likely to be lower.
People in England were more likely to not pick up medicine or skip doses because of the cost compared with respondents in Scotland, Wales and Northern Ireland, where prescription charges have been abolished. There are a range of exemptions in England – for example for people over 60 or with certain health conditions – but advocacy groups say: Free prescriptions For all those with chronic conditions, economic pressures are worsening the health of those who cannot afford their medications, they say.
Compared to other health services, respondents in the UK reported the highest proportion of cost-related barriers to dental care, with many other countries experiencing similar issues. These issues are likely to be related to both user charges for NHS dental care and the declining proportion of dental practices providing NHS care. tendency In all four countries of the UK UK Social Attitudes Survey 2023More people (28%) were ‘very dissatisfied’ with NHS dental care than any other NHS service.
The UK is not alone in offering affordable and accessible dental care. Research on Dentistry in Europe On average, more than half of dental care costs are paid out of pocket in the countries surveyed, making dental care the most common treatment people miss out on for financial reasons. Unmet need for dental care is lower in countries with more comprehensive public insurance (e.g. Germany) and affordable voluntary health insurance (the Netherlands).
