Today, we’re speaking to Dr Charlotte Paddison, who is currently non-executive director at Royal Papworth Hospital, and formerly a Senior Fellow and co-lead for Primary Care at the Nuffield Trust.
Title of paper: Implications of skill-mix change in general practice: secondary analysis of data from the GP Patient Survey
Available at: https://doi.org/10.3399/BJGP.2025.0360
To the authors’ knowledge, no previous studies have investigated the impact on patient trust or perception of needs met when patients are unsure what type of health professional they have seen. Using data from a large national survey, this study found that patients expressed lower confidence and trust, and were less likely to report their needs were met in general practice consultations when they were not sure who their appointment was with. The results are novel in demonstrating that the combination of not knowing who you saw and a remote appointment is particularly problematic for patient trust.
Transcript
This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.
Speaker A
00:00:01.600 - 00:00:58.530
Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for taking the time today to listen to this podcast.
In today's episode, we're speaking to Dr. Charlotte Patterson, who is currently non Executive Director at Royal Papworth Hospital and formerly a Senior fellow and co lead for Primary Care at the Nuffield Trust.
We're here to discuss the paper she's recently published here in the BJGP titled Implications of Skill Mix Change in General Practice Secondary Analysis of Data from the GP Patient Survey.
So, hi, Charlotte, it's really lovely to meet you and to talk about your work and I just really wanted to start by exploring how we know that the composition of the general practice team is evolving with the increasing scope of multidisciplinary work. Really? And I wondered if you could just give us some of the context for this work and what you wanted to do here.
Speaker B
00:00:58.850 - 00:02:04.870
Absolutely. Nada.
So what we really wanted to understand was how two big shifts in policy are shaping the experience of patients care when they come to the GP practice. Why do we think that was interesting or potentially important?
Basically, we've seen two big changes happening at the same time in the last five years. So.
So we've seen the shift to multi professional team working with many more different types of health professionals working in general practice and at the same time, separately, we've seen a massive increase in the number of appointments delivered remotely. So what we wanted to know is what those changes really mean for patients.
We also know that some patients feel confused about who they're seeing and when they turn up to a GP appointment at the surgery, whether that's an appointment with a GP or a physician's associate or a social prescriber.
And this led on to another really important question for us in this study, which is what happens when patients are confused or uncertain about who they've seen and what does that mean for patient trust? Those are the kinds of questions we wanted to answer.
Speaker A
00:02:05.350 - 00:02:39.730
So this was an analysis of the 2023 GP Patient Survey, which is sent to patients registered in English general practices.
And I think the key thing for this work and what you've outlined just in terms of what you're saying right here, was that the survey asks people who their last general practice appointment was with and whether they had confidence and trust in that person and if their needs were met. And just given what you were describing, I wanted to move straight on to what you found.
What did the patient say about trust and how did it Vary by different patient characteristics.
Speaker B
00:02:40.050 - 00:03:27.890
Sure. So what we found in relation to trust. Nada.
Is that while every 2, 2 in every 3 patients reported they definitely had trust and confidence in the health professional they saw at their GP practice. And that's very positive.
We also found at the same time, there's a minority of patients, around 7%, who reported they did not at all have confidence and trust in their last GP practice appointment. And we found that trust is lower among patients who are younger, from minoritised ethnic backgrounds and living in more deprived areas.
So that's what we found in relation to trust. We also found that patients are confused about different roles of health professionals working in general practice.
And we've found this is likely to affect around one in every 20 patients.
Speaker A
00:03:28.370 - 00:03:30.290
That seems quite a lot, actually, doesn't it?
Speaker B
00:03:30.530 - 00:04:26.740
Yes.
And it's also we found, looking at the GP general practice patient survey, we found that the proportion of patients who feel confused about who they're seeing has gone up over time.
What I can tell you is that if we look backwards over time, the national survey data shows the percentage of patients who are unsure who their last appointment was with has more than doubled in six years. In 2018, it was around 1.9% of patients. In the 2024 survey, this had gone up to 5% of patients.
And at the same time, we've also seen a decline in confidence and trust. So what we can say there is that confidence has declined by around 5% over that same time period.
So 5 percentage points from 69% of patients saying, yes, definitely they had confidence and trust in the health professional they saw in 2018. But by 2025 that's dropped to 64%.
Speaker A
00:04:27.220 - 00:04:46.100
And I think that almost reflects what's happening in practice with the increasing number of other roles working in general practice as well. And I think one of the really striking findings here is that patients reported much lower trust when they weren't sure which professional they saw.
Do you want to talk us through that and why you think that is?
Speaker B
00:04:46.630 - 00:06:26.190
Absolutely. So what we've seen in terms of context here is that a lot of change happening in general practice, much of it taking place at the same time.
So we've seen in terms of multi professional team working, there are 40,000 additional non GP non nurse staff working in general practice, which is a whopping 387% per patient increase over a nine year period.
At the same time, we've also seen this huge policy focus on rapid access, delivering more remote appointments, working at scale and a shift to digital and online as well. So there's a lot going on in general practice all at the same time.
And we can also see alongside this changes in patients confidence and satisfaction with how general practice is working. So that's sort of a zoomed out, bigger picture lens.
We can see that in terms of the British Social attitude survey in 2024, almost half of all people said they were quite dissatisfied with how general practice was working. But looking back in time, if we look back to 1983, we see that only 13% of people were dissatisfied with how general practice was running.
And even looking back just 10 years ago, in 2016, that figure is 16% of the of people in the British Social Attitude Survey who were dissatisfied with general practice. So we're seeing massive shifts across multiple aspects of general practice.
At the same time, we're seeing a significant shift in the proportion of people who feel that they are satisfied with what's happening in terms of the care they're receiving from general practices.
Speaker A
00:06:27.070 - 00:06:35.070
And I guess that relates to some of the issues with trust and potentially not knowing who people are seeing in practice as well.
Speaker B
00:06:36.170 - 00:07:12.390
Absolutely.
So in our findings, what we found was that the combination of not knowing who you saw and a remote appointment is really problematic for patients in terms of trust and confidence.
So to give a flavour of this, when patients were not sure what health professional, what type of health professional they saw or spoke to, and this was a remote appointment, so an appointment by phone or video or message, the likelihood of reporting confidence and trust decreased by up to 80% when compared to patients who saw a GP in person at their practice.
Speaker A
00:07:12.470 - 00:07:48.910
And we did a podcast with Richard Baker talking about trust in healthcare professionals as well.
And one of the things he highlighted was that actually trust is really important in that patient clinician interaction, because, you know, that trust actually builds some foundation towards whether people might want to come back to the practice, they might want to take up that advice or management that's been suggested by the clinician they see.
So I think not only are you seeing these associations, but it's actually really drilling down to why trust is so important as well in these...
