The Aviva Health of theNation IndexFebruary 2013
Contents3	Foreword4	   Looking for the perfect practice. Life as a GP in the UK6	   What’s up? Health trends on the increa...
ForewordWe’re always ready to take on board the views of thepeople who matter most: it’s what helps us focus onproviding p...
Looking for the perfect practiceLife as a GP in the UKA GP’s practice already shoulders the burden of a diverse range of r...
The working dayGPs in the UK offer the complete spectrum of careto people in their local community. From in-surgeryappoint...
What’s up?Health trends on the increaseGPs deal with a wide variety of health concerns. Some are major issues, some arerel...
Which conditions are GPs expecting to treat                                                  Most GPs believe the workingm...
We asked the GPs taking part in our survey about a               Three quarter of GPs (75%) believenumber of factors that ...
So how are we feeling today?Health awareness among patientsAnalysis of trends is what helps us plan ahead: our products an...
The whole truth?75% of the patients we spoke to told us they were self-                                                   ...
Time to visit the GP                                            How often do you visit your GP?                           ...
Caring for each other                                                            If you don’t check, why not?It was good t...
Differences of opinionAs we’ve seen from their approaches to visiting a GP, our study highlights thatmen and women have di...
Spotlight on mental healthWorrying signsA great deal of our GPs’ time is spent dealing with mental health issues. It’s sti...
Over half of our respondents (52%) told us that they’ve                                                                   ...
Spotlight on the workplaceWorking harderA ‘Fit Note’ is the informal name for the Statement of Fitness for Work; a compute...
Spotlight on joint replacementsHips and kneesThis year we looked at ‘replacements’, putting a focus on the experiences ofr...
So do we care about care?Patients’ views on funding careWhether or not it’s to do with absence from work, it’s important t...
Engaging with the NHSGPs’ views, patients’ opinionsWe asked patients what they thought about the quality of care provided ...
ReferralsFrom patient, to GP, and othersOver the last 10 years, medical advances mean that recommendations for treatmentma...
How do GPs decide which specialist a patientsees, or where they’re treated?                                               ...
Which conditions do GPs find most challenging to refer for specialist attention?Consistent with our previous Health of the...
Aviva's Health of the Nation report
Aviva's Health of the Nation report
Aviva's Health of the Nation report
Aviva's Health of the Nation report
Aviva's Health of the Nation report
Aviva's Health of the Nation report
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Aviva's Health of the Nation report

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We’re always ready to take on board the views of the people who matter most: it’s what helps us focus on providing products and services that people really need. This is the tenth year in which we’ve conducted our Health of the Nation study, canvassing the opinions of GPs right across the UK. This year we’ve extended our research to include the views of 1,000 patients to understand their experiences of healthcare in the UK.

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Aviva's Health of the Nation report

  1. 1. The Aviva Health of theNation IndexFebruary 2013
  2. 2. Contents3 Foreword4 Looking for the perfect practice. Life as a GP in the UK6 What’s up? Health trends on the increase9 So how are we feeling today? Health awareness among patients14 Spotlight on mental health16 Spotlight on the workplace18 So do we care, about care? Engaging with the NHS23 What have we learned? Health of the Nation – a 10-year anniversary
  3. 3. ForewordWe’re always ready to take on board the views of thepeople who matter most: it’s what helps us focus onproviding products and services that people really need. This is the tenth yearin which we’ve conducted our Health of the Nation study, canvassing theopinions of GPs right across the UK. This year we’ve extended our researchto include the views of 1,000 patients to understand their experiences ofhealthcare in the UK.For us, the Health of the Nation study has become an Patients have also given us their views. We’ve askedinsightful means of examining key health issues over a them about health matters; how they are, or aren’t ableperiod of time. It helps us gauge how the environment to seek the levels and quality of care they’re expecting,is evolving and identify stakeholder views that could help and which steps they’re taking to engage with theinfluence changes to our products and services. medical profession for support and more information about their health and wellbeing.As in previous years, this time we’re looking at GPs’lives and their views on the working environment; the The result? Another insightful cross-section of opinionstrends they’ve been identifying in the patients they’re on the state of our nation’s health services. We hope youseeing and, in particular, the continuing impact on their find this Health of the Nation study as useful as we haveworkload of mental health issues and health concerns found it to be revealing.arising from the workplace.We’ve canvassed GPs on their views about healtheducation and the information, or lack of it that affectsthe patient-doctor relationship; we asked for opinionson the quality of both established and potential futureclinical pathways, and we questioned GPs about theirengagement with the NHS. Mark Noble,Bearing in mind the changes that may happen as a Managing Director, Health andresult of Clinical Commissioning Groups (CCGs) coming Corporate Benefits, UK & Ireland Lifeinto effect from April 2013, our study has highlightedsome of the situations in which GPs still appear to needmore support, and reasons why patients may suffer theconsequences of an evolving service. Aviva Health of the Nation Index Report  3
  4. 4. Looking for the perfect practiceLife as a GP in the UKA GP’s practice already shoulders the burden of a diverse range of responsibilities:to individual patients as well as regulating bodies and Primary Care Trusts.The Royal College of General Practitioners has agreed that Highlightseffective commissioning will depend on continuous analysisof a community’s needs, and the design, specification and • 0% of GPs’ time is spent dealing with minor concerns 2procurement of services to meet those needs. Inevitably, the that could have been seen to by practice nurses oronus will fall on GPs to collect data that can be analysed to may not have warranted an appointment at all. Ashelp achieve those aims. insufficient time with patients is still our GPs’ greatest concern, we believe this clearly emphasises the need forBut it is, perhaps, thanks to the diverse nature of their work more initiatives (and resources) that could help directthat the majority of GPs (73%) have told us they’re deriving patients to the most appropriate support.moderate or high levels of satisfaction from their jobs. • ithout countrywide guidelines to help prioritise the WIt will be interesting to see if this changes over the next many factors involved, GPs are - on average – givingtwelve months, as the impact of commissioning takes 78% of patients an open referral through the choosefull effect. and book system. However, most patients are unable to compare the quality or cost of treatment that’s beingThe likelihood is that GPs may feel more obliged to be recommended, and may be choosing a referral pathwayinvolved in administrative activities than they are at present. based on convenience alone.Reassuringly, our study reveals their focus is still clearly onattending to patients’ clinical concerns. • lder GPs are concerned about the impact of the Health O and Social Care Bill, but also see the appearance of CCGs as an opportunity to procure better services for their patients. On average GPs spend 67% • Ps in Northern Ireland appear to be happiest, with G 50% citing job satisfaction levels as high; in the of their time South West however, over a quarter (26%) said their with patients. satisfaction levels were low.4 Aviva Health of the Nation Index Report 
  5. 5. The working dayGPs in the UK offer the complete spectrum of careto people in their local community. From in-surgeryappointments that will be dealing with psychological,physical and social concerns through to off-site attendancein clinical centres and, if necessary, their patients’ homes.A broad skill-set is involved that includes an opportunity toprevent illness as well as treat it.

On average, how is a GP’s working daycurrently divided?We asked GPs to break down their working day. Responsesshowed there’s an opportunity to free up more ‘patienttime’, by delivering resources that would better informindividuals about medical health matters. Just sevenGPs, less than 3%, told us part of their working day wascurrently spent teaching, training or educating and raising • Ps are, on average, contracted to work 36 hours per Ghealth awareness. week, but most appear to be working 42 hours or more.Reassuringly however, a low 3% of GPs’ time was • hile 45% of the GPs we spoke to expected those Wcommitted to dealing with cases that should have been hours to stay the same, over half (51%) expected to beseen by personnel in an Accident and Emergency unit. working longer hours in the future.On average:• 9% of the working day was spent dealing with medical 3 Year on year, our studies show issues that required a GP’s attention we’re making GP appointments for• 0% of the day was spent dealing with social care issues 2 problems that could be dealt with or the ‘worried well’ by a practice nurse or that may not• 6% of the day was taken up with administration or 1 need medical attention at all. More practice issues awareness of health matters couldOn average, a fifth of GPs’ working days are spent taking help address this situation, andcare of issues that either a practice nurse could deal with free up GP’s time to deal with more(9%), or dealing with minor medical concerns that didn’twarrant professional medical attention (11%). important medical cases. On average, what percentage of time are GPs spending with patients per week? 82% 76% 74% 71% 70% 69% 69% 68% 68% 64% 58% 56% Wales North East East Anglia Yorkshire Northern Scotland North West South West London South East West East the Humber Ireland Midlands Midlands Aviva Health of the Nation Index Report  5
  6. 6. What’s up?Health trends on the increaseGPs deal with a wide variety of health concerns. Some are major issues, some arerelatively minor, but we’ve looked back at our first Health of the Nation study toremind ourselves about health concerns that appeared to be on the increase adecade ago – and compared those with the trends we’re seeing today.Topping the list ten years ago were ME and Chronic • ith evidence that people with mental health WFatigue Syndrome; obesity, stress, depression and conditions are feeling less stigma, it could be the casealcoholism. And in some respects, the landscape has that those with symptoms of stress, depression andchanged relatively little – those issues are still prevalent anxiety are simply more open to asking for help.in the top ten conditions on the increase. • owever, our 2012 Health of the Workplace study H This year however, an alarmingly high proportion of revealed many people believe they’re having to workGPs (84%), identified stress and anxiety issues being harder as a result of changes in the economic climatethe greatest upward trend in their practices; 55% cited in recent years, and that this is having a tangible effectother mental health issues as being noteworthy. Media on their overall mental health. Just under a third of thecampaigns and Government initiatives may be helping employers we spoke to had introduced initiatives toto raise awareness of help for mental health issues, help manage workplace stress, but the employees weand this could, in turn, be having a positive effect and spoke to believed much more could be done.encouraging patients to engage more with their GPs ingeneral. But with so many patient cases being presented 20% of the GPs we spoke to saidmore often, the question quickly arises – what could bedone to address the underlying causes of that stress and they believed Government-backed,anxiety, both at home and in the workplace? patient education could help reduce instances of the conditions they’re dealing with most often. For which conditions have GPs noticed an increase in patient numbers over the past year? 84% 55% 53% 50% 44% 40% 36% 26% 25% 21% 16% 12% 10% 3% 3% 2% Stress / Mental Dementia Obesity Alcoholism Musculo- Diabetes Irritable ME / Cancer Arthritis Migraines Heart Stroke Other Asthma Anxiety health and and drug skeletal Bowel Chronic Disease issues Alzheimer’s addiction conditions Syndrome fatigue excluding syndrome stress and anxiety6 Aviva Health of the Nation Index Report 
  7. 7. Which conditions are GPs expecting to treat Most GPs believe the workingmore often over the next year? environment is responsibleAs they deal with patients who have already made for increases in mental healthappointments, it’s natural for GPs to have an opinion on theconditions they’re likely to see most in the future, too: problems, back pain, and obesity. 21% 20% 20% 13% 12% 3% 1% 2% 2% 2% 2% Other stress / work related Diabetes Obesity Mental Drug and Cancer Musculo- Tobacco Other Heart depression / stress health issues alcohol abuse skeletal injury related illness conditions anxiety amongst e.g. back pain elderlyOver the last five years, have GPs seen the working environmenthave more of an impact – or less – on the following illnesses? RSI Back pain Stress Depression Alcoholism Headaches Drug abuse Eating Eye problems ME / CFS Obesity disorders Stayed the same Fallen RisenAre work initiatives working?We work alongside employers to help them promote access to a clinician who can offer advice to help manageimprovements in health and wellbeing among their symptoms, and (without the need for a GP’s appointmentemployees. Unfortunately, it looks as though the or referral) make recommendations for appropriateworkplace is still having a notable impact on the rise in ongoing treatment.cases of certain conditions, and one stands out above the With such a large proportion of claims being made in thisrest. With 93% of GPs saying they attribute it directly to a area, it’s not a surprise to see that 50% of GPs believerise in cases of stress, there’s a compelling case for more the working environment is responsible for the casesmental health services – such as stress counselling, or the of back pain that they are seeing. Obesity can also besupport provided by an employee assistance programme – linked to musculoskeletal pain: this is one of the reasonsto be made available to employees. we encourage employers to promote improvements inAround a third of the claims we deal with under our diet and fitness levels to their employees – using a healthcorporate healthcare policies are for musculoskeletal initiative such as MyHealthCounts, for example.injuries, dealing with aches and pains in the back, neck,muscles and joints. Our Back-Up service provides prompt Aviva Health of the Nation Index Report  7
  8. 8. We asked the GPs taking part in our survey about a Three quarter of GPs (75%) believenumber of factors that could have been affecting thehealth of their patients in general over the last 5 years: the economic climate is having ahad they noticed poor diet, for example, being a greater significant impact on the health ofinfluence in the cases they were seeing. their patients.Have these factors had more or less impact on patients over the last 5 years?Poor diet Smoking100% 100%80% 80%60% 58% 60% 43%40% 33% 40% 26% 31%20% 8% 20% 0% 0% More impact Less impact No change More impact Less impact No changeAlcohol Drugs100% 100%80% 80% 63%60% 60% 50%40% 32% 40% 37%20% 20% 14% 5% 0% 0% More impact Less impact No change More impact Less impact No changeLack of exercise Economic climate100% 100%80% 80% 75% 64%60% 60%40% 40% 23%20% 12% 20% 14% 50% 0% 0% More impact Less impact No change More impact Less impact No changePollution Emotional working environment100% 100%80% 64% 80% 71%60% 60%40% 25% 40% 10% 19%20% 20% 10% 0% 0% More impact Less impact No change More impact Less impact No changePhysical working environment Emotional home environment100% 100%80% 80% 71%60% 42% 60% 43%40% 40% 25%20% 15% 20% 5% 0% 0% More impact Less impact No change More impact Less impact No changeHaving seen the increases in cases of some conditions action: 64% of GPs told us that a lack of exercise wasbeing attributed so significantly to the workplace, it was impacting their patients’ health.perhaps to be expected that the economic climate is beingseen as having a negative impact on the health of patients However, it does look as though we’re seeing a positivein general. And unfortunately, although the Olympics may reduction in the effects of nicotine addiction. For 43% ofhave stimulated greater interest in sport across the nation, GPs, the effects of smoking have made less impact on theat the moment it looks as though we have yet to take health of their patients over the last year.8 Aviva Health of the Nation Index Report 
  9. 9. So how are we feeling today?Health awareness among patientsAnalysis of trends is what helps us plan ahead: our products and services evolve to meetpeople’s actual health needs. As GPs are seeing more patients presenting with someconditions, it appears that patients are becoming more health-aware in general. What’sinteresting is that their propensity to self-diagnose has also increased significantly.How do you rate your health? When, in 2011, the Government launched its Public Health Responsibility Deal to help improve the management of our health services, it said that 2% ‘everyone has a part to play in improving public health’ – including individuals themselves. 10% 15% With that in mind it’s interesting to see what steps the public takes to inform themselves about health issues and monitor or improve their own wellbeing. 28% In this study, we placed a particular emphasis on self-diagnosis – asking views on health and the reasons why and how people try to find out the cause of symptoms they’re experiencing. 45% Very good Good Average Not very good PoorAre there benefits to self-diagnosis?Ten years ago, the GPs we spoke to estimated that around Today, with so much more information readily available15% of their patients looked up information about their online, it’s no surprise that more and more individuals arecondition before visiting the surgery. Two thirds had seen self-educating in advance of an appointment. Sources ofan increase in this trend; almost 70% of those GPs thought insight vary, but not surprisingly almost half the patients wethose patients’ behaviour had had a positive impact on spoke to (44%) are turning to the Internet for information.their subsequent health.Do you self-diagnose, if you’re unwell? Why do you self-diagnose? 1% Yes, I look on the internet • 9% of patients want to be more informed 2 when they see their GP Yes, I buy kits from the Pharmacy Yes, I judge my condition on my previous • 3% self-diagnose out of curiosity, but not instead 3 23% experience / illness of visiting a GP Yes, I use informative TV programmes44% • 31% self-diagnose to avoid seeing a GP 6% Yes, I read magazines • % self-diagnose because they had no faith 7 Yes, I ask my friends and family for advice in their GP 25% No, Never Aviva Health of the Nation Index Report  9
  10. 10. The whole truth?75% of the patients we spoke to told us they were self- 8%diagnosing before seeing a doctor. But although 82% 28%of GPs have seen an upward trend in people looking forinformation, GPs have a very different perception of howmany people are actually researching their symptoms 64%before having a personal consultation.• nly 5% of GPs believed that as many as three-quarters of O their patients were self-diagnosing prior to an appointment. I don’t self-diagnose because I think this would• nly 13% were of the opinion that half their patients O cause me to worry more were looking for information. I don’t self-diagnose because it’s best to just see your doctor in person• 7% thought a quarter of their patients or fewer 6 I don’t self-diagnose because it’s too time consuming would self-diagnose in advance.Our research shows that although patients are largelywilling to self-diagnose, they’re also less than likely toshare the fact they’ve done some research with their GP.A quarter of the patients we spoke to told us they neverself-diagnose. However, this is not the negative insight itmay first appear to be, because 64% of people believed itwas simply better to see a GP in person, and 28% believed 2%self-diagnosis would raise concerns rather than lower them. 15% 23%Do GPs think it’s beneficial for patients toself-diagnose before an appointment?Without a guarantee of its validity, patients may be 39% 21%sceptical about medical information that’s been sourcedsomewhere other than through their GP. However, itlooks as though some of us are using the data as abenchmark, from which to value or potentially challenge Yes, it can be very helpfula doctor’s views. A significant percentage – 39% – of Yes, but only if they are then willing toGPs appreciated the efforts that patients made, but sawself-diagnosis as a challenge if patients were unwilling to No, it causes scare mongeringaccept a diagnosis. No, I think it serves no benefit at all It varies from patient to patient10 Aviva Health of the Nation Index Report 
  11. 11. Time to visit the GP How often do you visit your GP? 40%Visiting a GP may not always be convenient, but neither is 37%illness. We asked people to tell us how often on average Men Womenthey visited a GP, and why. The answers were intriguing, 35%not least because they show a marked difference inattitudes between men and women. 31% 31% 30%• 0% of men said they rarely become ill compared to 3 21% of women. But 35% of men said they’d changed their views on visiting a GP in recent years, primarily as 25% they’d become more aware of how important it is to 22% look after your own health. 20% 18%• or almost a fifth of men (17%), visits to the GP had F 17% become more frequent. Only 14% of men hadn’t visited 15% their GP in the last three years, compared to 7% of 14% women, and – knowing that routine check-ups are a 11% good idea – 13% of men and 22% of women cited 10% 9% this as the main reason for visiting the doctor. 7%Different approaches to health 5% 9%On the whole, it appears that men are less likely to pay a 4%visit to their GP than women. 0% ly k th s s ar erWe asked ‘what were the reasons for the delay?’ th th ee ai ye ev on on on D w N m a m m a e a e nc e six nc e re O• 1% of women said they would suffer in silence if 5 nc O y th er O y Ev er unwell as there were jobs to be done; compared to this, Ev only 44% of men took the same approach.• 7% of men, however, were likely to take time off and 2 go to bed, instead of going to their GP, compared to just 21% of women.• ver a fifth of our survey’s respondents (21% men, O 20% women) said they’d take medicine ‘to keep going’ rather than go to their GP.• 9% of women would wait to see if the symptoms 2 went away, 16% blamed their inability to get a quick appointment and 9% said it would be a struggle to make an appointment that suited working hours. In comparison, 21%, 14% and 9% of men gave the same answers respectively The ease with which patientsHowever, we also asked about attitudes to making an can or cannot make a GP’sappointment – what, if any, would be the reasons to delay. appointment is still a concern.Over a quarter of the women we spoke to (28%) saidthey’d never avoided going to see their GP if they wereunwell. But although some are visiting their GPs more In all, 24% of the patients wefrequently, over a third (39%) of the male respondents to spoke to said that, in somethis survey had put off going to see their GP. way, their GP’s unavailabilityHappily, only 2% of the men and women we spoke to said influenced a delay in seekingthey would ‘milk an illness for all it’s worth’. medical help. 48% are suffering in silence. Aviva Health of the Nation Index Report  11
  12. 12. Caring for each other If you don’t check, why not?It was good to see that most people were aware of 6%their partners’ general health. But there was also a slight 25% 11%difference in the way men and women then approachedtheir concerns: 23%• 3% of men could persuade their partner to see a GP; 4 a slightly higher percentage of women, 46%, had the 35% same influence.• 9% of men had not raised a concern about their 2 I think I am too young to need to There are no historical issues in my family and I think partner’s health; only 17% of women reserved these things are hereditary opinions in the same way. I don’t think I need to I don’t know how to I am too busy and never remember • 3% of men had discussed something that was 1 worrying them about their partner’s health, but seen no result from the conversation; 17% of women had made unsuccessful attempts to raise concerns. These are alarming statisticsThe good news is that 10% of the men and women wespoke to had successfully persuaded partners to makelifestyle changes for the better. Interestingly, 10% of • or the quarter of women Fwomen had exercised those changes (such as diet), while who don’t self-check, 32%only 5% of men had taken the same action. say they’re too busy andFeeling better don’t remember and an equalSelf-examinations involve checking testicles and breasts proportion (32%) say theyfor physical changes: when you know how your body don’t know how.normally looks and feels, any changes in appearanceshould be easier to notice. The media has raisedawareness about the importance of self-examination, • f those men who don’t self- Obut it appears there’s still some way to go in educating check, 37% say they don’teveryone as to its value. know how to; while 30%Do you self-check for signs of testicular cancer or don’t think they need to checkbreast cancer? for signs of breast cancer or• nly 75% of the women we spoke to do any O testicular cancer self-examination.• lower percentage – only 60% – of men checks A their bodies in the same way. How often do you check? 40.9% 19.6% 8.6% 4.5% 5.8% 4.5% 3.9% 4.6% 3.2% 2% 1.4% 0.7% 0.4% at I ks th s s ar ly rly ld er w ily y th th kl /b e ar ou no ye th Da ee on la er tim ee h on on Ye gu O w sh tk m a W m m ow ery Re ice 3 n’ I a 2- 2 3 as Do ice sh Ev Tw y y y er er n tw er fte Ev Ev Ev or so e ta nc No O12 Aviva Health of the Nation Index Report 
  13. 13. Differences of opinionAs we’ve seen from their approaches to visiting a GP, our study highlights thatmen and women have differences in opinions about health matters in general.It transpires that most people take responsibility for their • omen were also more willing to say they would be Wown care, but we asked some pertinent questions about more likely to follow health fads, but equally, 64%engagement with health services in general. of women considered they took health matters more seriously than men.• 7% of the women we spoke to said they would 8 be the person to make a decision about which GP • 0% of the women we spoke to said they were most 7 to see; only 63% of men we spoke to made the likely to carry the responsibility of care if someone in same judgement. the family was unwell. Only 34% of men voiced the same opinion – that a man would be most likely to• hen it comes to being responsible for researching W play the role of carer. insurance that could pay for medical care, 53% of those carrying out research themselves were men.• 8% of those carrying out the purchase of private 4 medical insurance were men – women accounted for 59% of the respondents who said they were most likely to be keeping up to date with health news.The gender division was also noticeable in perceptions of care, as were views across the country. We asked people’sopinions regarding the quality of health treatments being received in their area. I have no point of reference 4% 4% 15%It depends on what treatment is required 6% I think it is poor 9% 8% 38% I think it is sufficient 40% 35% I think it is good 42% Women14% of respondents in the North West believed health services in their area were comparatively poor; by contrast, just1% of the respondents in Scotland shared the same opinion.70%60% I think it is good50% I think it is sufficient40% I think it is poor30% It depends on what treatment is required20% I have no point of reference10% 0% Yorkshire East West East London South South Wales Scotland Nothern North North and the Midlands Midlands East West Ireland East West Humber Aviva Health of the Nation Index Report  13
  14. 14. Spotlight on mental healthWorrying signsA great deal of our GPs’ time is spent dealing with mental health issues. It’s still themost prevalent type of illness, with 84% of GPs seeing more patients than everbefore suffering from stress and anxiety.Across the country, opinions vary as to the reasons for this Just under half the GPs we spoke to (47%) believe there’sincrease. In the North West and South West, GPs believe still a stigma associated with mental health issues, whichchanges in diagnostic criteria are the cause. Financial may be preventing people from seeking help.pressures could be the reason for more mental healthproblems, according to GPs practicing in London, the But it’s worth noting that 39% of GPs thought mediaSouth East, East Anglia and the Midlands, and Yorkshire campaigns were having a positive impact on that situation,and the Humber region. most notably in the North West, where 59% of GPs shared this view.An interesting opinion came from the East Midlands, whereGPs blame the increase in mental health issues on the useof social media for friendship and resulting isolation.Do GPs agree that mental health is one of the Do GPs agree there’s a lack of support for them,most pressing priorities for the NHS? regarding these health concerns? 59% 68% 36% 21% 11% 4% Yes Neutral No Yes Neutral NoProblems such as anxiety, depression, stress and phobias are very common. Talking Therapies is a Government-sponsored, nation-wide service that offers help to people with those problems. Are GPs prescribing medication (anti-Are GPs seeing long waiting lists for Talking depressants), when they believe TalkingTherapies in some areas? Therapies would be more beneficial? 84% 74% 20% 12% 3% 6% Yes Neutral No Yes Neutral NoLess than a quarter of the GPs we spoke to (23%) believed that access to Talking Therapies such as cognitive behaviouraltherapy would improve over the next few years. A telling statistic is the fact that 77% of GPs believed the workplace isone of the biggest causes of stress and anxiety for patients in the UK.14 Aviva Health of the Nation Index Report 
  15. 15. Over half of our respondents (52%) told us that they’ve Of the people we spoke to, 22% said they were nowsuffered from one mental condition or another during feeling better; 9% said they were still unwell and 21% oftheir lifetime; many had experienced symptoms aligned our survey said they still experienced symptoms from timewith more than one type of illness – and the majority of to time. It was encouraging to see that 57% of peoplepeople (74%) knew someone else who had suffered or would not be embarrassed to admit having a mentalwas suffering from mental health problems. health problem.We asked patients to detail which types of mental health issue they’d experienced:40% 35%35% 31%30%25% 23% 21%20%15% 14% 14% 10%10% 7% 5% 5% 5% 5% 1% 0% Work-related stress Mild anxiety and / or depression related to Digestive disorder related to stress / Frequent headaches SAD (Seasonal Phobias Depression OCD stress or trauma Panic attacks Paranoia anxiety e.g. IBS Affective Disorder) related to stress / anxiety Chronic fatigue / ME Bi-polar disorderWhat support did you receive for these conditions? The majority of patients (51%) felt that a period of 2 to I was prescribed drugs such 58% as anti-depressants 3 weeks was the maximum time they should wait for a referral to counselling or a psychological service, to I was referred for counselling / cognitive behavioural therapy 32% find out more about and get support for that condition. It’s worth noting that the 18-week maximum waiting I was referred for a specialist consultation 29% period set by the NHS does not apply to non-medical, consultant-led mental health services. Most peopleI was told to reduce my hours / signed off work 24% (85%) were understandably concerned that a condition could worsen if they had to wait a long time before I was referred for further tests 14% getting a referral.I was told to take more exercise 14% The GP sent me away with 8% no support 6% OtherIt’s alarming to note that 8% of patients believed they GPs share those patients’ concerns:were sent away from their GP having been given nosupport for one type of mental health issue or another. • 50% of GPs believe their local trust provides a poor service for patients with mental health issues.Nearly three-quarters of the patients we spoke to (73%)don’t think the Government and / or the NHS do enough • 37% of GPs believe the service is poor for patientsto tackle mental health problems. with depression, one of the highest prevalences of mental health issue in our survey. Aviva Health of the Nation Index Report  15
  16. 16. Spotlight on the workplaceWorking harderA ‘Fit Note’ is the informal name for the Statement of Fitness for Work; a computer-completed version was introduced in July 2012 with the aim of further smoothingthe process for GPs who are helping employees get back to work as soon as possible.There was reason to believe the formalised Fit Note would Overall however, it appears GPs still feel the onus shouldprovide a useful platform for GPs to open discussions with be on companies and their staff to take more responsibilitypatients about their health, with a view to helping them for their health in the first place, which would hopefullyreduce long-term sickness absence – a clear benefit to lead to a reduction in the need for GP appointments.employers, as well as employees. There’s an even opinionon whether or not it’s working: • 5% of GPs thought employers could do more to help 8 their staff get back to workIs the fit note an effective tool? • 5% of GPs thought employers could do more to help 7 their employees stay healthy • 1% of GPs thought the NHS was not appropriately 7 36% resourced to help employees return to work Those look like substantial figures. However, it’s vitally important to keep statistics in context. 32% 32% • e asked GPs whether or not they had a close enough W relationship with patients to understand their individual needs in terms of making a successful return to the Yes Neutral No workplace after illness or injury. Only 50% felt they did.16 Aviva Health of the Nation Index Report 
  17. 17. Spotlight on joint replacementsHips and kneesThis year we looked at ‘replacements’, putting a focus on the experiences ofrespondents who’d had operations to replace hip or knee joints in particular.According to the National Joint Register, there were over Over a quarter of the people we spoke to (28%) said84,000 hip and more than 87,000 knee replacements in ‘everyday’ things, like driving or getting shopping done,England alone in 2011/12. would be their primary concern if a knee joint or hip needed to be replaced.Of the people we spoke to for this study, 9% had sufferedfrom conditions resulting in the replacement of one or 34% said that not being able to work, becoming amore of the following joints: hips, ankles, knees, elbows or burden, or not being able to support a family would worryshoulders (over 130 different operations in all). However, a them most.staggering 76% of respondents said they knew someonewho had undergone at least one of those operations. 34% 33%However, joint replacement is not necessarily always linkedto the deterioration of health in old age: a quarter of therespondents who’d had an operation themselves were 25 15%years old or younger at the time; only a third (36 people in 12%all) were older than 60 years of age. We asked everyone in 4%our survey: 2%How would you cope if you needed a joint 2 weeks 1 Month 3 months 6 Months Six months to a year More than a yearreplacement, but weren’t able to have one?• 4% of respondents thought they would find a way to 2 How long would you be prepared to wait for cope financially and emotionally this type of operation?• 2% of respondents said they would complain, 14% 2 Waiting times for joint replacements vary across the thought it likely they would get depressed about the country. We also asked respondents to indicate how long situation they’d be prepared to wait for treatment – what did they consider to be a reasonable amount of time – if they were• 3% of respondents said they would change their 1 struggling to walk, and needed a hip or knee joint to be lifestyle in an attempt to cope replaced. On average, most people thought that a waiting time of between one and three months would be acceptable – which is roughly in line with the NHS’s 18-week maximum waiting period guidelines. 43% of people know someone who has had a hip replacement. 28% know someone who has had a knee replacement. Aviva Health of the Nation Index Report  17
  18. 18. So do we care about care?Patients’ views on funding careWhether or not it’s to do with absence from work, it’s important to be confident inthe person from whom we’re seeking help.The NHS provides varying levels of support across the (47%) said they would find money from their personalcountry, and our survey showed that patients have firm savings. However:opinions about their relationships with GPs and ‘thesystem’ in general. We asked, “If there were long waiting • 58% could afford £1,000 or lesstimes would you consider ‘going private’ for treatment?” • 27% could afford between £1,000 and £5,000• 55% said they wouldn’t be able to self-fund treatment • Only 5% could afford between £5,000 and £10,000• 3% felt they could claim on a private medical 1 So how would you pay for treatment? insurance policy Over a quarter (27%) of the respondents to our survey• 23% would find funds themselves to pay for treatment said they’d be prepared to borrow from friends or family, take out a loan or incur credit card debt to self-fund; 19%• % said they would suffer, and wait until 9 were prepared to re-mortgage their property. We believe treatment was available from the NHS these figures highlight the fact that many people areThe views on what was an acceptable price for improved aware of costs, but – without private medical insurancehealth varied. We asked how much people felt they could – they would be ill prepared to pay for treatment if theyafford, if they chose to self-fund treatment – almost half opted for private care. For many people, private medical insurance negates Probing further into their opinions as patients, we the need to worry about access to care irrespective of then asked: where they live. We asked respondents: “As a patient, what’s your outlook for the NHS?” What do you think of the postcode lottery system, in which some areas of the country offer better access to care for some conditions than others? I don’t have an opinion on this 5% I was not aware of this 7% Very concerned, I have no It depends on the condition - confidence in the leadership 7% I wouldn’t want my taxes spent on 3% of the DOH NHS conditions that aren’t essential Very concerned - I can’t It’s an unavoidable fact, 7% see a future for the NHS treatment quality cannot be 9% consistent across the country Concerned - I expect patient care I think people should ensure they and the breadth of services to 36% have health insurance to protect 3% decline in the future themselves from this Neutral - I feel that changes in the NHS will have little 27% I think people should be able to 13% impact on patients select where they get treated Optimistic - I have confidence in the leadership 10% I think it is very unfair 65% of the DOH NHS Optimistic - I feel that the direction the NHS is going in will 8% deliver better care for patients18 Aviva Health of the Nation Index Report 
  19. 19. Engaging with the NHSGPs’ views, patients’ opinionsWe asked patients what they thought about the quality of care provided by theNational Health Service (NHS) today.Opinions varied, but there’s an indication that the general I don’t have an opinion on this 3%public is concerned that some areas of the NHS arecoming under undue pressure. I believe the NHS varies 5% across the country• 3% of people thought the NHS had declined in its 1 quality of services over the last decade I think the NHS has declined in 13% quality over the past decade• ust 15% felt the UK’s National Health Service was one J I think some areas of the NHS are under a lot of pressure: care of 26% of the best state-provided health services in the world the elderly for example I think generally speaking theVery few people – 3% – declined to share an opinion NHS is very good, but some areas 37% are stronger than otherson this. I think our health service is one of the best in the world 15%For which services do GPs feel the NHS provides a good service? Where does theNHS not deliver an adequate service to its customers?80%70%60%50%40%30%20%10%0% Alcoholism Alzheimer’s Arthritis Asthma Cancer Cataracts Diabetes Eating Heart disease Hip / knee Depression Mental Stress / Musculo- People Strokes Obesity and drug and disorders replacements health issues anxiety skeletal wanting addiction dementia (excluding conditions health advice stress / needing anxiety) physiotherapy Poor Adequate GoodOpinion highlightsIn general, GPs feel the NHS doesn’t provide adequate services to help patients with eating disorders; obesity is also poorlyaddressed. In contrast, cancer, cataracts and diabetes are conditions for which individuals are catered relatively well.This is interesting, because 20% of GPs cited diabetes as being one of the conditions most likely to increase overthe coming year – and diabetes can be linked with obesity. Sadly, irrespective of being due to general budget cuts,redistribution of funds, or allocation of funds or ‘more life-threatening conditions’, 16% of GPs expect their local NHS tostop offering treatment for eating disorders in the next 5 years. Aviva Health of the Nation Index Report  19
  20. 20. ReferralsFrom patient, to GP, and othersOver the last 10 years, medical advances mean that recommendations for treatmentmay have changed. However, the referral process – from a patient’s initial concernsthrough to the first appointment with a specialist who can make a detailed diagnosis– has altered very little.In the patient’s journey, the role of a GP extends Aviva is contributing to this investigation, assisting thefrom counsellor, confidante and assessor, to both Competition Commission as they look at factors that couldcommunicator and facilitator. It’s the GPs’ role to make be affecting GPs referral choices:appropriate referrals for more investigation of a conditionor symptoms, but data to inform their decision is not • re potential clinical outcomes taken into consideration Areadily available. enough by GPs?There’s a great deal of variation in the way GPs make • s there enough transparency regarding the cost, Ireferrals, and relatively few patients would query quality and availability of one specific treatment – intheir recommendation. comparison to others?However, as part of the Competition Commission’s • erhaps most importantly, are patients’ views being Pinvestigation into the supply and acquisition of private considered enough during the referral process that’shealthcare services in this country, the referral process is supposed to afford them the best possible treatmentundergoing close scrutiny. and recovery?According to GPs, who owns the referralprocess? 14% Only 15% of GPs believe their 9% patients ‘own’ the referral process. 15% We believe there’s an urgent 61% need for patients to see more information, and be more involved GP Patient in the decision-making processes Specialist Insurer that affect their treatment and care. Other (combination)The majority of GPs - 62% - believed they were completely in control of the referral process. Given the emphasis ontransparency in recent years, and the desire that patients should have an opportunity to become more involved in thedecisions surrounding their treatment, a surprisingly low number - 15% - believed that, ultimately, their patients werethe decision-makers at the point of referral.20 Aviva Health of the Nation Index Report 
  21. 21. How do GPs decide which specialist a patientsees, or where they’re treated? 24%Whenever it’s practical, GPs are likely to give patients anoption to choose their specialist and place of treatment. 6% 48%We believe the decision a patient takes, at that point, ismore likely to be based on geographical convenience than 22%data available about quality of care or cost of treatment.The referral options provided by GPs may be based on I gave them a choice of specialists and hospitals to choose fromprevious experience or reputation rather than a quantified I select the specialist I feel is best for themmeasurement of clinical outcomes. I ask the patient which specialist they’d like to see and refer them to the one they choose I give the patient an open referralFor private treatment, which factors do GPsconsider in their referrals? 1%When referring patients for private treatment that will beeither self-funded or covered by an insurance policy, thereare many factors that have to be considered in addition to 30%the individual’s immediate clinical needs. 35%However, one of the challenges faced by the CompetitionCommission (and patients) is the lack of consistency 3%or guidelines informing the way in which GPs should 29% 2%prioritise those factors, one over the other. Clinicians takea very ‘individual’ approach to making a recommendation. Quality of care / outcomes Quality of facilitiesWe believe that greater transparency regarding the Waiting times for NHS treatments Financial penalty of premium increase when an insurercomparative quality and costs of a treatment – from facility does not cover the full cost of treatmentto facility, or even among specialists and/or anaesthetists Choice of specialist / consultant Availability of advanced treatments / technologiesfor example – could help. On average, GPs are giving 78% of patients an open referral. However, most patients are unable to compare the quality or cost of a treatment – and may be selecting a referral pathway based on convenience alone. Aviva Health of the Nation Index Report  21
  22. 22. Which conditions do GPs find most challenging to refer for specialist attention?Consistent with our previous Health of the Nation reports. We asked which referrals GPs were finding most challenging.It’s worth noting that, in comparison with the results of our first Health of the Nation study ten years ago, the referrallandscape has changed very little – although fewer GPs are finding the process quite such a challenge, overall.2012: top 10 conditions and % of GPs who find these referrals challenging45% 39%40%35%30% 24%25% 20%20% 17% 17% 16% 16% 15% 14%15% 12%10%5%0% ME / Chronic Obesity Drug / alcohol Mental health Stress Depression Stress (non Back pain Headaches Irritable Bowel fatigue syndrome abuse (exc. stress) (work related) work related) Syndrome2011: top 10 conditions and % of GPs who found those referrals challenging70% 60%60% 56% 53% 53%50% 45% 44% 40% 40%40% 36% 35%30%20%10%0% ME / Chronic Food Eating Stress Learning Stress (not Drug abuse Obesity Musculo- Mental fatigue syndrome allergies disorders (work related) difficulties work related) skeletal health issues in children2003: top 10 conditions and % of GPs who found those referrals challenging80% 76% 72%70% 59%60% 55%50% 44% 44% 43%40% 37% 34% 31%30%20%10% 0% ME / Chronic Food Fibromyalgia Eating Learning Alcoholism Drug abuse Headaches Musculo- Obsessive fatigue syndrome allergies disorders difficulties skeletal Compulsive in children Disorder Tired of dealing with ME and CFS? As with last year’s survey, GPs told us that they were still struggling to refer patients on for more specialist insights to Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS). Over a period of ten years, these are still the number one conditions that GPs find most challenging to refer on for specialist attention. What’s most alarming however, is that 42% of GPs thought the NHS would no longer provide services for ME and CFS by 2015.22 Aviva Health of the Nation Index Report 

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