'Access to GPs has dramatically improved!' claims the government. 'Nonsense, it's got worse!' yells the Daily Express.

'Access to GPs has dramatically improved!' claims the government. 'Nonsense, it's got worse!' yells the Daily Express.

'Doctors might get paid more for working anti-social hours,' opine The Timesand The Daily Telegraph. 'That's a New Labour cock-up!' cry the Daily Mailand the Lib Dems.

As the independent charity that carried out this survey of 10,000 patients registered with a GP in England (as it had the previous three such annual surveys), the Picker Institute might be left to conclude that there is spin, damned counter-spin, and statistics.

The truth is, as the summary to the survey report states, that there has been 'steady progress' in access. The 12 per cent of patients who last year reported that they could not get an appointment within two days was a decrease of 1 per cent per year from 2004. 'Room for further improvement', said the report.

But if some patient frustration with regard to access remains - with 58 per cent saying they had problems getting through to their local practice by phone - there is an equal frustration with the continuing failure of some doctors and other health professionals to involve patients in decisions made about their care and treatment.

Patient engagement in primary care is apparently worsening when it should be improving.

Many of the key indicators centre around medication: for most patients this is the most significant area of decision making in primary care. In this sample, more than half the respondents had been given new prescriptions in the past 12 months.

Only 55 per cent said they were involved as much as they wanted to be in decisions about their medicine - down 4 per cent on 2005 and 2004. Some 12 per cent said they were not involved at all in medication decisions.

Most - 79 per cent - said they were definitely given enough information about the purpose of their medicine, but this was down 1 per cent on 2005 and 2004. Only 58 per cent said they were given enough information about the possible side-effects of the medicine - down 3 per cent on 2005 and 2004.

The next debate
Let's be clear: patients still love their doctors. In this as in all previous surveys, GPs and their allied professionals continue to score extremely highly for showing their patients empathy and respect, and they generate high levels of trust and confidence.

But overall, the 31 per cent of patients who could not say they were as involved as they wanted to be in decisions about their care and treatment remains the same as in 2004. This suggests little movement so far towards a 'patient-centred NHS'; towards commissioning care with patients that supports them to manage their own care within the community; or towards implementing new guidelines on standards from the General Medical Council which include an injunction to work with patients on shared decisions.

All patient experience surveys show that fast access is an important priority for patients, but so is the desire for effective support to enable them, their families and their carers to be involved in decisions about their care.

Payment for flexible opening hours may not be the priority. There still needs to be a transformation in the patient-doctor relationship. The new debate should be about assessing doctors' performance on the level of their patients' engagement.

Angela Coulter is the chief executive of the Picker Institute. Later this year the Picker Institute and the Academy of Medical Royal Colleges will be holding an action conference on implementing the patient-centred standards in Good Medical Practice.