General practice across England: How has patient satisfaction changed around the country?

Variation in patient satisfaction across areas has increased since 2012 

Using the GP patient survey, we can aggregate practices’ results into sub-ICB areas.* There are no sub-ICBs that performed better in 2019 than 2012 – or in 2023 than 2019. And while there has been a decline in patient satisfaction** at every level, there is also substantial variation in the extent of that decline. In 2012, 92.9% of patients in the highest scoring sub-ICB reported a good experience of general practice, compared to 81.6% in the lowest scoring. The inter-quartile range (IQR, the difference between 25th and 75th percentiles***) also grew in that time. 

In 2012, the IQR was 2.6ppt. In 2023, that had almost tripled to 7.2ppt. 

But there are no sub-ICBs that have bucked the national trend by improving patient satisfaction. Areas that were doing well before the pandemic are still performing better. In better-performing sub-ICBs we found a strong relationship**** (an R-squared of 0.44) between patient satisfaction in 2012 and in 2019, and again between 2019 and 2023 (Figure 2).

_{* Sub-ICBs are NHS geographies that sit beneath the 42 integrated care boards (ICBs) in England. There are 106 sub-ICBs in England, with an average of approximately 600,000 patients in 2024 (the smallest had 117,657 patients and the largest 2,884,883).} 

_{** Throughout this report we will use ‘patient satisfaction’ interchangeably with patients’ ‘overall experience of general practice’.} 

_{*** The 25th percentile value is the sub-ICB that is one quarter of the way between the bottom and the top of the distribution of patient satisfaction. The 75th percentile is the sub-ICB that is 75% of the way through the distribution.} 

_{**** Across this report, we will interpret R-squared relationships in the following way: 0 = no relationship; 0–0.1 = weak; 0.1–0.35 = moderate; 0.35+ = strong.}

Patient satisfaction is highest in the South West and lowest in London 

The gap between different regions has also grown. The South West is the stand-out region, showing the smallest fall in satisfaction (12.2ppt) and outperforming others both at the start and the end of the time period. The largest fall was in the South East (17.4ppt), while London was consistently the worst performing region. Between 2012 and 2023, the gap between these regions grew from 7.2 to 9.0ppt.

Satisfaction is lowest in the most deprived parts of the country 

Deprivation is also related to patient satisfaction. Looking at the deprivation of patients registered to a practice ⁶ Department of Health and Social Care, ‘Fingertips – National general practice profiles’, (no date), https://fingertips.phe.org.uk/profile/general-practice/data#page/9/gid/2000005/pat/204/par/U00000/ati/7/are/D82060/iid/93553/age/1/sex/4/cat/-1/ctp/-…  shows us that the lowest satisfaction rates are found in the practices with the most deprived quintile* of patient lists in England in 2023. In 2012, some 86.1% of patients in this quintile had a good experience of general practice but this fell by 17.9ppt to just 68.2% in 2023 – the largest fall. In contrast, the least deprived quintile had the smallest drop in that time: 13.3ppt, from 90.5% to 77.2%. 

Taken together, this shows the gap in patient satisfaction between the most and least deprived quintiles more than doubled from 4.4ppt in 2012 to 9.7ppt in 2023.

_{* The most deprived quintile shows practices with the top 20% of deprivation scores in England.}

Variation in patient satisfaction has increased since 2012

The variation in satisfaction over time is even more evident when looking at the practice level. Here, there has been a dramatic shift in the distribution of patients reporting a good experience of general practice. In 2012, just under half of practices (47.7%) had very high (>90%) patient satisfaction. In 2023, this had fallen to less than 1 in 10 practices (9.1%). At the other end of the distribution, in 2012 fewer than 1 in 100 (0.4%) practices had patient satisfaction under 60%. This had risen to more than one in six (17.9%) by 2023.

Many practices achieve nearly all QOF targets 

We also look at the relationship between QOF achievement and practice characteristics in this report. We do that because QOF is another indicator of the quality of care in a practice. The government chooses QOF targets that are intended to improve health outcomes for patients. An example of a clinical target is that the practice maintains a register of patients with coronary heart disease (CHD) and then manages those patients’ condition. Practices are deemed to be effectively managing CHD if patients are taking an effective medication, such as aspirin. ⁸ NHS England, ‘Quality and outcomes framework guidance for 2023/24’, January 2024, www.england.nhs.uk/long-read/quality-and-outcomes-framework-guidance-for-2023-24/#section-2-summary-of-all-indicators4  Achieving or missing QOF targets are not the only metric of quality of care for a practice, but they do reflect the government’s priorities for the service. 

It is harder to compare QOF achievement over time because the government frequently changes the number and type of QOF targets. But it is possible to look at the distribution of QOF achievement in 2023/24.

In that year, 11.8% of practices achieved between 99% and 100% of their QOF targets and 78.5% of practices achieved more than 90%. Despite this relatively tight distribution of QOF achievement, there is still sufficient variation to compare to other characteristics of general practice (more of which below).