Accessing a GP is more difficult for some

In my experience, people working in the health and social care sector tend to fall into one of two camps: those who are persuaded by numbers and those who are persuaded by stories. At National Voices, we see it as our job to help bring these two tribes together in pursuit of a shared vision of making care better for everyone.

Since I joined the team as chief executive in May, we have had a significant focus on how we bring together these quantitative and qualitative worlds in primary care.

On the one hand, we have the numbers, which tell us that GPs and all those within primary care are busier than ever. Activity data, for example, shows practices are delivering 10 per cent more appointments per day compared with 2019.

At the same time, the numbers in the GP Patient Survey show the worst satisfaction scores since records began. The drop may not have been as dramatic as we saw in 2022, but the downward trend in recent times is bad news for all of us.

Then we have the stories. The insights from our 200 member charities, gathered through continual engagement with millions of people, show that for particular communities the reality is even worse than the headline numbers suggest.

Digging beneath the headline numbers

These stories encourage us to look deeper at the numbers. Indeed, when we analyse the GPPS data against different groups we see that people in the most deprived areas are significantly less likely to have received the support they need to manage their condition compared to those in the least deprived (59 per cent vs 71 per cent).

Accessing GP appointments is also harder for some, for example, if you are Black British or Caribbean/African you are 10 percentage points less likely to have been able to book a GP appointment in advance than white respondents.

On continuity of care, it is those who have accessibility needs and/or tend to feel more marginalised who most benefit from this, yet are least likely to receive it. For example, if you are D/deaf or a British Sign Language user you are much more likely to have a preferred GP than those who are not (71 per cent vs. 41 per cent). Unfortunately, however, you are also 5 percentage points less likely to get an appointment with your preferred GP than someone who can hear.

Crucially, when we add the stories to the numbers, we can start to understand why these things are going wrong. We can see how closing online booking systems out-of-hours actually exacerbates health inequalities, and how poor administration means patients with additional communication needs consistently struggle to get the care they need.

Working with people to find the answers

The Primary Care Recovery Plan is a great example of NHS England bringing together numbers with stories to understand the real problems in GP land. And it took on board a number of the changes identified by National Voices in the development of our own vision for the future of primary care.

But even numbers and stories can only take us so far. To really put the right solutions in place then we need GP teams to be working directly with their communities. This can be supported by strategic pieces of engagement at the national and integrated care system level to help practices do this.

For example, we need to see work going on across the country that involves patients and communities in designing how practices roll out digital phone systems, or scoping how care navigators can be best deployed. By working together, we can ensure that we consistently get the basics right in a way that will improve the system for everyone.

This type of engagement or co-production can seem a bit scary to some, especially for hard-pressed GP practices who are already massively overstretched. But that is precisely why the National Voices coalition, and our friends in the Healthwatch network, at the Patients Association and thousands of other voluntary, community and social enterprise organisations are here.

Our members have invested their time in building authentic and purposeful relationships with their communities and can facilitate engagement. This is an invaluable resource for the NHS, but we cannot keep doing this without additional investment from the centre. Every other sector knows the value of understanding what their “customers” need and the NHS must embrace this too.

This investment is not just about money. It is about a sharing of power with communities, accepting that decision-makers don’t have all the answers and that designing services together is more likely to bring solutions that will work the first time. And where initiatives don’t generate the results we want, a shared responsibility makes it easier to spot and address emerging problems sooner.

Getting this combination of numbers, stories and collaboration right is the key to making the NHS fit for the future.

National Voices’ nine-point vision for improving primary care can be found here.