Aviva's Health of the Nation report

The Aviva Health of the
Nation Index
February 2013

Contents

3 Foreword

4 Looking for the perfect practice. Life as a GP in the UK

6 What’s up? Health trends on the increase

9 So how are we feeling today? Health awareness among patients

14 Spotlight on mental health

16 Spotlight on the workplace

18 So do we care, about care? Engaging with the NHS

23 What have we learned? Health of the Nation – a 10-year anniversary

Foreword
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.
For us, the Health of the Nation study has become an Patients have also given us their views. We’ve asked
insightful means of examining key health issues over a them about health matters; how they are, or aren’t able
period 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 the
influence 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 opinions
trends they’ve been identifying in the patients they’re on the state of our nation’s health services. We hope you
seeing and, in particular, the continuing impact on their find this Health of the Nation study as useful as we have
workload of mental health issues and health concerns found it to be revealing.
arising from the workplace.

We’ve canvassed GPs on their views about health
education and the information, or lack of it that affects
the patient-doctor relationship; we asked for opinions
on the quality of both established and potential future
clinical pathways, and we questioned GPs about their
engagement with the NHS.
Mark Noble,
Bearing in mind the changes that may happen as a Managing Director, Health and
result of Clinical Commissioning Groups (CCGs) coming Corporate Benefits, UK & Ireland Life
into effect from April 2013, our study has highlighted
some of the situations in which GPs still appear to need
more support, and reasons why patients may suffer the
consequences of an evolving service.

Aviva Health of the Nation Index Report 3

Looking for the perfect practice
Life as a GP in the UK
A 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 Highlights
effective commissioning will depend on continuous analysis
of a community’s needs, and the design, specification and • 0% of GPs’ time is spent dealing with minor concerns
2
procurement of services to meet those needs. Inevitably, the that could have been seen to by practice nurses or
onus will fall on GPs to collect data that can be analysed to may not have warranted an appointment at all. As
help achieve those aims. insufficient time with patients is still our GPs’ greatest
concern, we believe this clearly emphasises the need for
But it is, perhaps, thanks to the diverse nature of their work more initiatives (and resources) that could help direct
that 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
W
It will be interesting to see if this changes over the next many factors involved, GPs are - on average – giving
twelve months, as the impact of commissioning takes 78% of patients an open referral through the choose
full effect. and book system. However, most patients are unable
to compare the quality or cost of treatment that’s being
The likelihood is that GPs may feel more obliged to be recommended, and may be choosing a referral pathway
involved in administrative activities than they are at present. based on convenience alone.
Reassuringly, our study reveals their focus is still clearly on
attending 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

The working day

GPs in the UK offer the complete spectrum of care
to people in their local community. From in-surgery
appointments that will be dealing with psychological,
physical and social concerns through to off-site attendance
in clinical centres and, if necessary, their patients’ homes.
A broad skill-set is involved that includes an opportunity to
prevent illness as well as treat it.  

On average, how is a GP’s working day
currently divided?
We asked GPs to break down their working day. Responses
showed there’s an opportunity to free up more ‘patient
time’, by delivering resources that would better inform
individuals about medical health matters. Just seven
GPs, less than 3%, told us part of their working day was
currently spent teaching, training or educating and raising
• Ps are, on average, contracted to work 36 hours per
G
health 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
W
committed to dealing with cases that should have been
hours to stay the same, over half (51%) expected to be
seen 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 could
On average, a fifth of GPs’ working days are spent taking help address this situation, and
care 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’t
warrant 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


What’s up?
Health trends on the increase
GPs deal with a wide variety of health concerns. Some are major issues, some are
relatively minor, but we’ve looked back at our first Health of the Nation study to
remind ourselves about health concerns that appeared to be on the increase a
decade 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
W
Fatigue Syndrome; obesity, stress, depression and conditions are feeling less stigma, it could be the case
alcoholism. And in some respects, the landscape has that those with symptoms of stress, depression and
changed 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 work
GPs (84%), identified stress and anxiety issues being harder as a result of changes in the economic climate
the greatest upward trend in their practices; 55% cited in recent years, and that this is having a tangible effect
other mental health issues as being noteworthy. Media on their overall mental health. Just under a third of the
campaigns and Government initiatives may be helping employers we spoke to had introduced initiatives to
to raise awareness of help for mental health issues, help manage workplace stress, but the employees we
and 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 in
general. But with so many patient cases being presented 20% of the GPs we spoke to said
more often, the question quickly arises – what could be
done 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
anxiety


Which conditions are GPs expecting to treat Most GPs believe the working
more often over the next year?
environment is responsible
As they deal with patients who have already made for increases in mental health
appointments, it’s natural for GPs to have an opinion on the
conditions 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
elderly

Over the last five years, have GPs seen the working environment
have 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 Risen

Are work initiatives working?
We work alongside employers to help them promote access to a clinician who can offer advice to help manage
improvements in health and wellbeing among their symptoms, and (without the need for a GP’s appointment
employees. Unfortunately, it looks as though the or referral) make recommendations for appropriate
workplace 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 this
rest. With 93% of GPs saying they attribute it directly to a area, it’s not a surprise to see that 50% of GPs believe
rise in cases of stress, there’s a compelling case for more the working environment is responsible for the cases
mental health services – such as stress counselling, or the of back pain that they are seeing. Obesity can also be
support provided by an employee assistance programme – linked to musculoskeletal pain: this is one of the reasons
to be made available to employees. we encourage employers to promote improvements in
Around a third of the claims we deal with under our diet and fitness levels to their employees – using a health
corporate 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


We asked the GPs taking part in our survey about a Three quarter of GPs (75%) believe
number of factors that could have been affecting the
health of their patients in general over the last 5 years: the economic climate is having a
had they noticed poor diet, for example, being a greater significant impact on the health of
influence 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 Smoking
100% 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 change

Alcohol Drugs
100% 100%

80% 80%
63%
60% 60% 50%
40% 32% 40%
37%
20% 20% 14%
5%
0% 0%

Lack of exercise Economic climate
100% 100%

80% 80% 75%
64%
60% 60%

40% 40%
23%
20% 12% 20% 14% 50%
0% 0%

Pollution Emotional working environment
100% 100%

80% 64% 80% 71%
60% 60%

40% 25% 40%
10% 19%
20% 20% 10%
0% 0%

Physical working environment Emotional home environment
100% 100%

80% 80% 71%
60% 42% 60%
43%
40% 40%
25%
20% 15% 20%
5%
0% 0%

Having seen the increases in cases of some conditions action: 64% of GPs told us that a lack of exercise was
being attributed so significantly to the workplace, it was impacting their patients’ health.
perhaps to be expected that the economic climate is being
seen as having a negative impact on the health of patients However, it does look as though we’re seeing a positive
in general. And unfortunately, although the Olympics may reduction in the effects of nicotine addiction. For 43% of
have stimulated greater interest in sport across the nation, GPs, the effects of smoking have made less impact on the
at the moment it looks as though we have yet to take health of their patients over the last year.


So how are we feeling today?
Health awareness among patients
Analysis of trends is what helps us plan ahead: our products and services evolve to meet
people’s actual health needs. As GPs are seeing more patients presenting with some
conditions, it appears that patients are becoming more health-aware in general. What’s
interesting 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 Poor

Are there benefits to self-diagnosis?

Ten years ago, the GPs we spoke to estimated that around Today, with so much more information readily available
15% of their patients looked up information about their online, it’s no surprise that more and more individuals are
condition before visiting the surgery. Two thirds had seen self-educating in advance of an appointment. Sources of
an increase in this trend; almost 70% of those GPs thought insight vary, but not surprisingly almost half the patients we
those 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 programmes
44%
• 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


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 for
information, GPs have a very different perception of how
many 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 largely
willing to self-diagnose, they’re also less than likely to
share the fact they’ve done some research with their GP.

A quarter of the patients we spoke to told us they never
self-diagnose. However, this is not the negative insight it
may first appear to be, because 64% of people believed it
was 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 to
self-diagnose before an appointment?
Without a guarantee of its validity, patients may be 39%
21%
sceptical about medical information that’s been sourced
somewhere other than through their GP. However, it
looks as though some of us are using the data as a
benchmark, from which to value or potentially challenge Yes, it can be very helpful

a doctor’s views. A significant percentage – 39% – of Yes, but only if they are then willing to
GPs appreciated the efforts that patients made, but saw
self-diagnosis as a challenge if patients were unwilling to No, it causes scare mongering

accept a diagnosis.
No, I think it serves no benefit at all

It varies from patient to patient


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 Women

they visited a GP, and why. The answers were intriguing, 35%
not least because they show a marked difference in
attitudes 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

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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 patients
However, we also asked about attitudes to making an can or cannot make a GP’s
appointment – what, if any, would be the reasons to delay. appointment is still a concern.
Over a quarter of the women we spoke to (28%) said
they’d never avoided going to see their GP if they were
unwell. But although some are visiting their GPs more In all, 24% of the patients we
frequently, over a third (39%) of the male respondents to spoke to said that, in some
this survey had put off going to see their GP.
way, their GP’s unavailability
Happily, only 2% of the men and women we spoke to said influenced a delay in seeking
they would ‘milk an illness for all it’s worth’.
medical help.

48% are suffering in silence.


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 approached
their 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 statistics
The good news is that 10% of the men and women we
spoke to had successfully persuaded partners to make
lifestyle changes for the better. Interestingly, 10% of
• or the quarter of women
F
women 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 and
Feeling better don’t remember and an equal
Self-examinations involve checking testicles and breasts proportion (32%) say they
for physical changes: when you know how your body don’t know how.
normally looks and feels, any changes in appearance
should be easier to notice. The media has raised
awareness about the importance of self-examination, • f those men who don’t self-
O
but it appears there’s still some way to go in educating check, 37% say they don’t
everyone 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 check
breast 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%
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Differences of opinion
As we’ve seen from their approaches to visiting a GP, our study highlights that
men 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
W
own 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’s
opinions 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%

Women

14% of respondents in the North West believed health services in their area were comparatively poor; by contrast, just
1% of the respondents in Scotland shared the same opinion.
70%

60%

I think it is good
50%
I think it is sufficient
40%
I think it is poor

30% It depends on what
treatment is required

20% I have no point of reference

10%

0%
Yorkshire East West East London South South Wales Scotland Nothern North North
and the Midlands Midlands East West Ireland East West
Humber


Spotlight on mental health
Worrying signs
A great deal of our GPs’ time is spent dealing with mental health issues. It’s still the
most prevalent type of illness, with 84% of GPs seeing more patients than ever
before 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’s
increase. In the North West and South West, GPs believe still a stigma associated with mental health issues, which
changes in diagnostic criteria are the cause. Financial may be preventing people from seeking help.
pressures could be the reason for more mental health
problems, according to GPs practicing in London, the But it’s worth noting that 39% of GPs thought media
South 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, where
GPs blame the increase in mental health issues on the use
of 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 No

Problems 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 Talking
Therapies in some areas? Therapies would be more beneficial?

84% 74%

20%
12%
3% 6%

Yes Neutral No Yes Neutral No

Less than a quarter of the GPs we spoke to (23%) believed that access to Talking Therapies such as cognitive behavioural
therapy would improve over the next few years. A telling statistic is the fact that 77% of GPs believed the workplace is
one of the biggest causes of stress and anxiety for patients in the UK.


Over half of our respondents (52%) told us that they’ve Of the people we spoke to, 22% said they were now
suffered from one mental condition or another during feeling better; 9% said they were still unwell and 21% of
their lifetime; many had experienced symptoms aligned our survey said they still experienced symptoms from time
with more than one type of illness – and the majority of to time. It was encouraging to see that 57% of people
people (74%) knew someone else who had suffered or would not be embarrassed to admit having a mental
was 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 disorder
What 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 people
I 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%
Other

It’s alarming to note that 8% of patients believed they GPs share those patients’ concerns:
were sent away from their GP having been given no
support 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 patients
to tackle mental health problems. with depression, one of the highest prevalences of mental
health issue in our survey.


Spotlight on the workplace
Working harder
A ‘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 smoothing
the 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 should
provide a useful platform for GPs to open discussions with be on companies and their staff to take more responsibility
patients about their health, with a view to helping them for their health in the first place, which would hopefully
reduce 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 opinion
on whether or not it’s working: • 5% of GPs thought employers could do more to help
8
their staff get back to work
Is 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.


Spotlight on joint replacements
Hips and knees
This year we looked at ‘replacements’, putting a focus on the experiences of
respondents 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%) said
84,000 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 suffered
from conditions resulting in the replacement of one or 34% said that not being able to work, becoming a
more of the following joints: hips, ankles, knees, elbows or burden, or not being able to support a family would worry
shoulders (over 130 different operations in all). However, a them most.
staggering 76% of respondents said they knew someone
who had undergone at least one of those operations. 34%
33%

However, joint replacement is not necessarily always linked
to the deterioration of health in old age: a quarter of the
respondents 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 year
replacement, 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.

So do we care about care?
Patients’ views on funding care
Whether or not it’s to do with absence from work, it’s important to be confident in
the person from whom we’re seeking help.

The NHS provides varying levels of support across the (47%) said they would find money from their personal
country, and our survey showed that patients have firm savings. However:
opinions about their relationships with GPs and ‘the
system’ in general. We asked, “If there were long waiting • 58% could afford £1,000 or less
times 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 are
The views on what was an acceptable price for improved aware of costs, but – without private medical insurance
health varied. We asked how much people felt they could – they would be ill prepared to pay for treatment if they
afford, 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 patients


Engaging with the NHS
GPs’ views, patients’ opinions
We asked patients what they thought about the quality of care provided by the
National 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 are
coming 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 the
Very few people – 3% – declined to share an opinion NHS is very good, but some areas 37%
are stronger than others
on 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 the
NHS 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 Good

Opinion highlights

In general, GPs feel the NHS doesn’t provide adequate services to help patients with eating disorders; obesity is also poorly
addressed. 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 over
the 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 to
stop offering treatment for eating disorders in the next 5 years.


Referrals
From patient, to GP, and others
Over the last 10 years, medical advances mean that recommendations for treatment
may have changed. However, the referral process – from a patient’s initial concerns
through 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 the
from counsellor, confidante and assessor, to both Competition Commission as they look at factors that could
communicator and facilitator. It’s the GPs’ role to make be affecting GPs referral choices:
appropriate referrals for more investigation of a condition
or symptoms, but data to inform their decision is not • re potential clinical outcomes taken into consideration
A
readily available. enough by GPs?

There’s a great deal of variation in the way GPs make • s there enough transparency regarding the cost,
I
referrals, and relatively few patients would query quality and availability of one specific treatment – in
their recommendation. comparison to others?

However, as part of the Competition Commission’s • erhaps most importantly, are patients’ views being
P
investigation into the supply and acquisition of private considered enough during the referral process that’s
healthcare services in this country, the referral process is supposed to afford them the best possible treatment
undergoing close scrutiny. and recovery?

According to GPs, who owns the referral
process?
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 on
transparency in recent years, and the desire that patients should have an opportunity to become more involved in the
decisions surrounding their treatment, a surprisingly low number - 15% - believed that, ultimately, their patients were
the decision-makers at the point of referral.


How do GPs decide which specialist a patient
sees, or where they’re treated? 24%

Whenever it’s practical, GPs are likely to give patients an
option to choose their specialist and place of treatment. 6% 48%

We believe the decision a patient takes, at that point, is
more 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 from
previous experience or reputation rather than a quantified I select the specialist I feel is best for them
measurement 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 referral

For private treatment, which factors do GPs
consider in their referrals? 1%

When referring patients for private treatment that will be
either self-funded or covered by an insurance policy, there
are 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 Competition
Commission (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 take
a very ‘individual’ approach to making a recommendation. Quality of care / outcomes
Quality of facilities

We believe that greater transparency regarding the Waiting times for NHS treatments
Financial penalty of premium increase when an insurer
comparative quality and costs of a treatment – from facility does not cover the full cost of treatment
to facility, or even among specialists and/or anaesthetists Choice of specialist / consultant
Availability of advanced treatments / technologies
for 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.

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 referral
landscape 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 challenging
45%
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) Syndrome

2011: top 10 conditions and % of GPs who found those referrals challenging
70%
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 children

2003: top 10 conditions and % of GPs who found those referrals challenging
80% 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.


Aviva's Health of the Nation report

Aviva's Health of the Nation report

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