Around 15 million people in England have a long-term condition, and offering care and services to support these people remains a key priority for the NHS (1). The ambition by 2020 is to make the NHS the best in the world at supporting people with long-term conditions to live healthily and independently, with better control over the care they receive (2)
Primary care has been identified as crucial to this, as people with long-term conditions are intensive users of health and social care services, with previous research showing they account for 50% of GP appointments (1). The GP Patient Survey (GPPS) provides valuable data which helps us understand more about the experiences of these patients in relation to general practice.
Who is affected?
Overall GPPS data shows 54% of people experience a long-term condition from a specific list. However older patients are more likely to have a long-term condition, unsurprisingly as many long-term conditions are associated with age (3). Older patients are also more likely to experience “multi-morbidity” which is the occurrence of multiple long-term conditions (4). GPPS data shows that almost three in five of those aged 65 or over experience two or more long-term conditions (58%) compared with 20% of those aged 18-34. The type of long-term condition reported also varies by age group. Younger patients (aged 18-34) are more likely to report experiencing asthma, long-term mental health problems or long-term back problems. Whereas those aged 65 or over are more likely to report experiencing high blood pressure, arthritis or diabetes.
Experience during last appointment
Patients with long-term conditions are more positive about their experience during their last appointment than those without. GPPS data shows they are more positive about a range of different aspects of their last GP appointment, such as the GP giving them enough time, listening to them, and treating them with care and concern. The same is true about their last nurse appointment.
However, again age plays an important part. Younger patients with a long-term condition report a poorer overall experience of their GP practice compared with their peers without a long-term condition. Older patients are more positive in comparison. For example, of those with a long-term condition nine per cent aged 18-24 report a poor experience, compared to just two percent of patients aged 65 or over. We know from previous research for the London Health Commission that these groups want different things from their GP. Those with a long-term condition emphasise the importance of seeing the same GP, and would rather wait longer for an appointment in order to do this.
Support from local services
For many patients with a long-term condition, the GP practice is not the only place where support can be found, and the NHS declaration highlights the importance of person-centred care across health and social care services (5). However, GPPS data shows that 17% of those with a long-term condition do not feel they have received enough support from local services and organisations to manage their health. Again, younger people are more likely to feel this way, with a quarter of those aged 18-24 saying they do not have enough support compared to nine per cent in the older age group (65 or over).
Other work by the Ipsos MORI ethnography team on behalf of NHS Improving Quality shows that people often feel the system is not set up to cope with their multiple and complex needs, and can feel there is no support linking all of their conditions, focusing on them personally and holistically. This need for a more joined up approach to supporting patients with LTCs was also shown in Ipsos MORI’s work for the London Health Commission, where the majority suffering from one or multiple conditions reported their conditions(s) are treated individually rather than as a whole.
Confidence managing health
Finally, GPPS data shows people with long-term conditions report lower levels of confidence in managing their health overall. Again, age plays an important part with higher levels of pessimism among the very youngest and oldest. Ipsos MORI’s work for the London Health Commission also showed the majority of those with an LTC haven’t been offered any self-care support, despite most reporting that having support to maintain their independence is more important than living longer.
It’s clear that all patients with long-term conditions need support from their GP and other local services, achieving a joined up approach to support them in managing their own health. However, it’s important that these services recognise the differences within this group, with age playing a part in experience of last appointment, support from local services and confidence managing their own health.
Ipsos MORI administers GPPS on behalf of NHS England. 2,157,769 questionnaires were sent out nationally, and 808,332 were returned completed between 3 January and 31 March 2017. This represents a response rate of 37.5%. Data is weighted to match the profile of the population. Read further technical information about how the survey works here.
For more information about the survey, and access to the data see www.gp-patient.co.uk.
1. Health, Department of. Long Term Conditions Compendium of Information. 2012.
2. https://www.england.nhs.uk/ourwork/ltc-op-eolc/ltc-eolc/. [Online]
3. https://www.england.nhs.uk/ourwork/ltc-op-eolc/older-people/improving-care-for-older-people/. [Online]
4. https://www.england.nhs.uk/blog/dawn-moody-david-bramley/. [Online]
5. England, NHS. Our Declaration: Person-centred care for long term conditions. 2015.