Primary care - public understanding and perceptions survey: analysis report

6. Conclusions

This report has presented findings from a nationally representative sample of 1,136 people aged 18 and over living in Scotland. The results offer insights into the three research themes in primary care, with a focus on general practice: finding health and service information; trust, confidence and experience with different professionals; and barriers to accessing and receiving care. These themes are related to the primary care outcomes for people; that we feel more informed and empowered when using primary care and that our experience of primary care is enhanced.

What & Where: Finding health and service information

Although self-reported knowledge of services and where to go to access primary care was high (78-90%), most respondents did not utilise the full range of primary care services and still saw General Practitioners as the first point of contact for primary care. For example, although the majority of respondents thought that community pharmacy was an appropriate place to access care, few people said they would contact their local pharmacist before seeing a GP. This suggests that, despite the work of recent campaigns, more work is needed to shift public knowledge and perception of the multi-disciplinary team, the availability of care via pharmacy and other parts of primary care, and how more appropriate care can be accessed, often more quickly and closer to home.

Respondents found it harder to find information about health problems than services, and those with fewer formal qualifications and limiting long term conditions reported both finding and understanding health information more difficult. Therefore, services (such as NHS inform) and primary care professionals need to continue to work to make health information as accessible as possible to ensure that certain groups are not excluded from feeling informed about their health.

Who: trust, confidence and experience with professionals

Awareness and trust was lower for other professionals in the general practice multi-disciplinary team than for doctors and nurses, and especially low for people providing links to non-clinical support and services and mental health workers. This may be linked to lower levels of awareness and experiences of these staff, but this survey did not gather sufficient data to test this. However, more time, awareness raising and trust building is likely needed for the public to engage fully in the new model of care. This may be especially true for people living in greater deprivation and those living with limiting long term illnesses.

While the majority of respondents reported a preference for GP signposting, most would be happy for this decision to be made by a receptionist. However, one third of people felt unhappy with this. It may be interesting to run these questions again to discern any impact of the national media campaign on the role of receptionists.

Those living in the least deprived SIMD decile found it easier to engage in their health care: they were more likely to report finding it easy to find information about specific health problems, express their health concerns, understand healthcare professionals and to ask questions of them until they understand. By contrast, those living with a limiting long term illness found engaging in their healthcare in this way more challenging. This suggests that different groups have different levels of agency and empowerment when accessing primary care.

These differences are complex and likely reflective of power structures and inequalities in Scottish society more broadly^[10]. This makes them difficult for primary care to tackle; these were results were found in spite of healthcare professionals giving an opportunity to ask questions, making sure their patients understood and displaying a high level of listening skills. This suggests that a different, more targeted and nuanced approach may be needed to empower patients with equity.

How: access and barriers in primary care

Despite significant disruptions to services due to COVID-19, the majority of people surveyed had accessed primary care service in the last 12 months, with the majority of most recent appointments happening face to face. Satisfaction ratings were significantly higher for face to face than phone or video appointments.

However, nearly half of people reported it was difficult to get an appointment at their general practice, suggesting that access issues are ongoing.

Avoidance, anxiety and not wanting to burden the NHS are creating barriers for some people who may not be accessing healthcare when they need it.

Despite the challenges outlined in this report, the majority of respondents felt satisfied with their most recent interaction with primary care.

Limitations

This survey was conducted with a thorough and robust methodology. However, it has some significant limitations outlined below:

• Although the survey asked about dentistry and community pharmacy, the majority of the questions focused on general practice and therefore generalisations across primary care are limited.
• Although the sample is a reasonable size, nationally representative and collected using robust methods, all methods are subject to bias. Additionally, some demographic variables could not be reported on due to low sample sizes (e.g. families with small children, ethnicity) and others were not collected (e.g. sexual and gender identity) and therefore any differences in the views of those groups are not reflected in the data. More work would need to be conducted to understand the views of these groups.
• This was a one-off, standalone survey and therefore no comparisons can be drawn across time. The primary care outcomes aim to measure improvements in experience and how informed and empowered people feel, and therefore the contribution this survey makes to measuring these outcomes is currently limited, as it only provides a single snapshot in time. It may be interesting to repeat parts or all of this survey in the future to discern how public perceptions change as recovery from the pandemic progresses and primary care reform becomes embedded across Scotland.
• This survey collected information about what, where, who and how people access care. However, as a quantitative survey with limited options and responses, it cannot say anything meaningful about why public perceptions are as they are or how to shift them. More detailed and qualitative work would be needed to address these questions.