UK worst on hospital waits but best on GP access, 10-country survey shows

UK general practice has been shown to perform well on access and speed of getting an appointment, in a large survey across 10 high-income countries.

A report from the Health Foundation said 97% of respondents in the UK said they had regular access to a GP with only the Netherlands scoring higher.

On getting an appointment on the same day or next day, 42% of the more than 3,000 UK patients surveyed said this was their experience with only the Netherlands and Germany higher at 50% and 49% respectively.

But the analysis of the 2023 Commonwealth Fund survey on experience of healthcare from 21,000 patients across Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the US and the UK highlighted a myriad of other ways in which the NHS is performing worse.

UK patients had the second-worst experience of being able to access healthcare other than A&E during evenings and weekends and a high proportion reported their GP did not always spend enough time with them in an appointment.

This has declined rapidly over time, with 85% reporting their GP spent enough time with them in an appointment in 2013 compared with 58% in 2023.

The Health Foundation report also noted the UK’s performance on hospital care is consistently near the bottom of the countries surveyed with long waits for specialist care a particular concern.

It found 11% of people in the UK were waiting a year or more for a specialist appointment and 19% were waiting a year or more for non-emergency surgery. Only Canada was comparable.

The UK also performed poorly on care coordination between GPs and specialists, the report said.

Access to care based on cost is also becoming more of an issue in the UK over time, with a quarter now skipping dental care. While NHS care is free, the proportion of people who did not visit or consult with a doctor for cost reasons has grown from 2% to 7% in 2023, which is a concerning trend, the report said.

Health Foundation’s assistant director of policy Ruth Thorlby said the report sheds more light on just how much work the government has to do to get the NHS back on its feet.  

‘The combined effect of the pandemic and below average spending growth has left the NHS in a fragile state. The Government is right to prioritise bringing down waiting lists, but that can only be done with a concerted effort to improve primary care and ensuring good coordination between hospitals and GPs.’ 

RCGP chair Professor Kamila Hawthorne said: ‘Given the intense workload and workforce pressures GPs are working under, it’s testament to the efforts of general practice teams that the UK performs well compared to other high-income countries, in terms of access to next day appointments.

‘We always try our best to offer timely care, based on the patient’s health needs, and of the 30 or so million consultations GP teams deliver every month, around 43% are on the same day.’ 

But she added it was clear that too many patients are struggling to access GP care and services and have enough time with their GP as well as being unclear where to turn if they fall unwell outside of routine hours.

‘GPs are as frustrated as their patients when this happens – but years of underfunding and poor workforce planning have left general practice on the brink. 

‘More and more people need our care – and with increasing numbers of patients living with multiple, complex, long-term conditions we need more time with them – but we simply do not have enough GPs to keep up, and the findings of this report show it’s our patients who are bearing the brunt. 

‘General practice is struggling, but with the right investment and initiatives to recruit and retain GPs we can turn things around, allowing GPs to deliver the safe and timely care that we are trained to provide, and spend more time with those patients who need it.’

Dr Andrew Buist and Dr Alan Stout, co-chairs of the BMA’s UK GP committee, said the report confirmed many patients’ experience of general practice across the UK with urgent Government intervention needed ‘to help us rebuild our profession’.

​‘While it’s promising to see that the UK performs well for patients getting access to same or next-day appointments, it’s clear that the level of care being given is not what doctors or their patients want.

​‘That the UK is ranked as one of the lowest countries for the amount of time GPs spent with patients, for example, is a symptom of decades of underfunding and what happens when GPs are expected to do more with less. It’s unacceptable, and things have to change.’​

Key findings from Commonwealth Fund survey

Access to a regular GP or GP practice

• Netherlands 99%
• UK 97%
• Canada 86%

Getting an appointment on the same or next day

• Netherlands 50%
• UK 42%
• Canada 24%

Very or somewhat easy to get medical care other than A&E on evenings or weekends

• US 38%
• UK 16%
• Sweden 10%

Does your GP spend enough time with you in an appointment

• Most countries ~ 80%
• Sweden 60%
• UK 58%

GP practice always or often helps to coordinate care you receive from other places

• Sweden 28%
• UK 50%
• Canada 69%

Waiting a year or more for a specialist appointment in past two years

• Netherlands 1%
• Canada 9%
• UK 11%

Source: Commonwealth Fund

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