The Aviva Health of the Nation Index - Spring 2012

 
The Aviva Health of the Nation Index - Spring 2012
The Aviva Health
        of the Nation Index
        Spring 2012

34297_GEN4421_BRO.indd 1      04/04/2012 19:57
The Aviva Health of the Nation Index - Spring 2012
Contents

          3     Foreword
          4     Key trends
          6     The GP practice
          8     The impact of technology
          10 GPs’ views on the proposed NHS reforms
          12 Quality of NHS services
          16 UK health trends
          18 A focus on public health
          20 What is Aviva doing to help?
          22 A focus on obesity
          26 A focus on mental health
          30 What does this mean?
          31 About Aviva

          Methodology
          Aviva commissioned extensive research among a panel of 205 GPs across the UK. The sample is broadly
          representative of the UK across age, gender, region, practice size (by patient numbers and number of GPs working
          in practice) and how long the GP has been practicing. GPs were interviewed between 10th - 15th of November
          2011. The research was conducted online on behalf of Aviva by independent research company Pollab.

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The Aviva Health of the Nation Index - Spring 2012
Foreword
        The Health of the Nation Index is Aviva’s comprehensive bi-annual study of
        GPs’ views on the National Health Service (NHS), their own practices and trends
        they’re seeing relating to the nation’s health. The results provide an incisive
        commentary on the position of healthcare at this moment in time, as well as an
        insight into how GPs are feeling about the future of the health service.

        With over 80%1 of total health expenditure in the UK being                                           Our last report showed that there’s a great deal of synergy
        consumed by the NHS, its performance and activities are an                                           between what GPs want and what the Government would like
        important determinant of the health sector as a whole. We’re                                         to achieve through its Health and Social Care Bill. However, it
        committed to understanding people’s experiences and views of the                                     also revealed that many GPs were anxious about the effect the
        health system to enable us to develop products and services that                                     Government’s proposals could have on the quality of care their
        fill gaps and complement the services being offered by the NHS.                                      patients will receive.

        Our report comes at a crucial time. The NHS is facing a period                                       A significant percentage of GPs (70%) cited NHS reform as their
        of unprecedented uncertainty. Not only are substantial NHS                                           key concern and confidence levels in the Government’s plans for
        reforms on the horizon – the Government’s controversial Health                                       clinical commissioning were low. Many GPs were worried that
        and Social Care Bill has now been passed – but it also faces the                                     their already busy workload would increase – further shifting
        challenge of having to find efficiency savings of £20 billion by                                     their time away from patient care.
        2015. In addition to this, the Government is proposing radical
                                                                                                             While the report highlighted a number of significant
        changes to public health services with the establishment of a
                                                                                                             improvements in the service provided to patients with serious
        new integrated public health service.
                                                                                                             conditions such as cancer and stroke, it also revealed that the
        General Practitioners (GPs) will be placed at the heart of the                                       quality of service available to patients with conditions such as
        Government’s reforms, recognising their unique position in                                           eating disorders, mental health issues, alcoholism and drug
        linking their patients’ experiences with an ability to influence                                     abuse and obesity remains inadequate.
        change in the health system. In surveying GPs from around the
                                                                                                             That’s why we once again shine a light on mental health issues
        country, our report offers a unique insight into the views of this
                                                                                                             in this report. We also look at the issue of obesity – both for
        key group of professionals.
                                                                                                             adults and children.
        Throughout the years we’ve tracked changes in GP’s working
                                                                                                             Some of the results are expected, others are surprising. No
        lives, considered trends in the nation’s health, identified what’s
                                                                                                             matter what your point of view we hope that you find this
        going well, and highlighted areas which GPs feel could be
                                                                                                             a thought provoking contribution as we move into what is
        improved – particularly in relation to patients’ experiences of the
                                                                                                             undoubtedly a challenging period for healthcare in the UK.
        health service.

        1
         The World Bank – Health expenditure, public (% of total health expenditure) – 2009 United Kingdom

                                                                                                                                                                                 3

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The Aviva Health of the Nation Index - Spring 2012
Key trends identified
        in this year’s report
           GPs remain focussed on patient care
           l   GPs continue to work long hours and are concerned about activities which detract them from patient care –
               such as paperwork.

           l   They continue to juggle a wide range of tasks within a working week including managing social care issues,
               minor medical issues which could be dealt with by a nurse and the needs of the ‘worried well’.

           l   GPs are concerned that the planned reforms of the NHS will mean that their work loads will increase and
               that their focus will be directed away from patient care towards management.

           l   Overall GPs note some improvements in NHS services, but some conditions continue to pose a challenge in
               terms of referrals.

           l   Despite all the issues they manage and the planned reforms of the health service, GPs continue to express a
               high level of job satisfaction.

           For more details please see pages 6-7

           The challenges of embracing new technologies to help manage patients’ health
           l   The Government is keen to demonstrate how technology can support people to live independently, take
               control and be responsible for their own health and care through ‘telehealth’ services.

           l   GPs are generally supportive of the use of internet search engines, NHS Direct, friends and family and
               smartphone apps to help patients manage their health and wellbeing. Our survey, however, suggests that
               GPs need greater convincing on the benefits of ‘telehealth’.

           For more details please see pages 8-9

           A softening of views on NHS reforms, but there’s still work to be done
           l   The NHS is just beginning its largest set of reforms in many years. But it will have to complete these reforms
               during one of the most sustained periods of funding restraint ever seen.

           l   Our survey reveals that GP attitudes are changing towards the Government’s reforms although there are still
               concerns.

           l   But the Government still has much to do to win the hearts and minds of this key group of professionals,
               central to their planned reforms. 32% of GPs say they have no confidence in the NHS reforms.

           l   Whilst the Government wishes to put the patient at the centre of decision making in the new NHS, very
               few GPs surveyed said that the reforms would give them more opportunities to get the best service for
               patients or offer patients better access to care.

           l   Significant concerns were also raised about the plans to transfer responsibility for public health to local authorities.

           For more details please see pages 10-11

        4 The Aviva Health of the Nation Index

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The Aviva Health of the Nation Index - Spring 2012
Quality of care is improving, but there still room for improvement
          l   GPs recognise that progress has continued to be made in the treatment of cardiovascular disease, cancer
              and strokes. Services are, however, regarded as poor for stress and anxiety, alcohol and drug addiction,
              depression, mental health issues and obesity – conditions which GPs say are on the increase.

          l   With the NHS’s £20bn efficiency challenge there are concerns about the future of some services. GPs feel
              that the NHS may not continue to provide services for ME/chronic fatigue, infertility and food allergies.

          For more details please see pages 12-15

          Obesity will be the biggest public health issue over the next year
          l   Obesity will be the biggest public health issue over the next year, say GPs, ahead of work related stress and
              drug and alcohol abuse.

          l   The rise in childhood obesity is particularly concerning – 80% of GPs say there has been an increase over
              the past 5 years, with significant numbers seeing an increase in the number of children with problems
              relating to obesity – such as mental health issues, diabetes and breathing difficulties.

          l   GPs consider sedentary lifestyles, poor diet and a lack of parental guidance to be mostly to blame for the
              increase in obesity.

          l   Improving individual and parental responsibility is regarded by GPs to be the main way of tackling obesity
              amongst adults and children.

          For more details please see pages 22 - 25

          ‘No health without mental health’- the need for action
          l   The launch in 2011 of the Government’s mental health strategy, ‘No health without mental health’, comes
              at a timely moment – since over three quarters of GPs say they’ve noticed an increase in the number of
              patients with mental health conditions.

          l   Mental health issues in young people, as with obesity, are reported to be increasing.

          l   Significant concerns have been raised about the quality of services available to this growing number of
              younger patients: 60% of GPs say their local NHS Trusts provide poor services for mental health issues
              amongst children over 5 years old.

          l   Against this backdrop, almost two-thirds of GPs say they have prescribed antidepressants in situations
              where they felt that psychological therapies or better social care would be a more appropriate treatment.
              This is mainly due to the long waiting lists for mental health services.

          For more details please see pages 26-29

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The Aviva Health of the Nation Index - Spring 2012
The GP Practice
         To understand a typical GP’s work life today, we asked a broad
         selection of GPs questions about time spent with patients,
         average working hours, job satisfaction as well as concerns about
         their profession.

         Working hours
         The average working week in the UK is 36 hours2 which was also the average number of hours worked by the
         GPs taking part in our previous Health of the Nation study, conducted last summer. Our recent survey finds that
         over two-thirds (70%) of GPs work at least this number of hours or more. Around half (49%) of GPs say they
         work more than 40 hours a week and 16% say they typically work more than 50 hours a week. Only 30% of GPs
         surveyed work fewer hours than the national average.

         Just under half (49%) of the GPs we surveyed believe that their working hours will stay the same over the next three
         years and 42% believe that their hours will go up. We consider in more detail the impact that the Government’s NHS
         reforms will have on GPs’ working lives on page 11 of this report.

            On average, in a typical week how many hours do you work?
                                     25%

                                     20%                                                                                 21%

                                                                                                                                         18%
        Percentage of GPs surveyed

                                     15%                                                                                                          16%
                                                                                                                                  15%

                                     10%                                                                       11%

                                                                                                   9%

                                      5%
                                                                                         5%

                                                                2%               2%
                                            0.5%
                                      0%
                                             Less             11-15             16-20   21-25    26-30       31-35       36-40   41-45   46-50    More
                                           than 10                                                                                               than 50
                                                                                                Number of hours worked

                                     70% of GPs work 36 hours
                                     a week or more

         2.
                    Office for National Statistics Labour Force Survey. 2011.

         6 The Aviva Health of the Nation Index

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The Aviva Health of the Nation Index - Spring 2012
How do GPs spend their time?
                                                                                                   Top 10 concerns GPs have
        Reassuringly our research this year again reveals that a large proportion of GPs say       about their profession
        they spend the majority of their time dealing with medical issues requiring a GP’s
        attention. Two in five (40%) GPs say that they spend between 26 – 50% of their
                                                                                                                      19%
        time with genuine medical issues, with a further 37% saying they spend 50% or                           20%             54%
        more of their time on issues needing a GP’s medical training.                                      21%

        GPs key concerns about their working life                                                        24%                             50%

        Given the level of change in the NHS combined with the introduction of professional
                                                                                                          25%
        appraisal and revalidation – which ensure doctors are up to date and fit to practise -
        we asked GPs about their key concerns with regards to their profession.                                 29%                39%
                                                                                                                        29%
        As with previous years, our survey finds that GPs, as a profession, work among some
        of the longest hours in the UK. However, their old frustrations about their profession
                                                                                                    1. Too much paperwork
        remain. As highlighted in our previous report, GPs are concerned about too much
                                                                                                    2. Dealing with patients who have
        paperwork and dealing with patients that have unrealistic expectations of the NHS.             unrealistic expectations
        A perennial concern is the inability to spend sufficient time with their patients – with    3. Inability to spend sufficient time
        39% of GPs in this year’s survey saying it was among their top three concerns about            with patients
        their profession.                                                                           4. The impact of the health reforms
                                                                                                    5. Quality of care provided by the NHS
        Another on-going worry for GPs is the concern about the quality of care that the UK
                                                                                                    6. Working hours
        healthcare system can deliver to patients - with 29% of GPs ranking this as a top
        concern. Our survey also shows that GPs say the impacts of the health reforms are           7. Lack of support for mental health issues

        much less important than other aspects of their professional life – only 29% of GPs         8. Lack of financial rewards
        rank this as a top concern, a significantly lower level of concern than in our previous     9. Insufficient time to spend on
                                                                                                       professional development
        report (70%). We consider the NHS reforms further on page 10 and 11.
                                                                                                    10. Dealing with patients that do not
        Despite the changes on the horizon, the responses mirrored our previous Health                  look after themselves
        of the Nation surveys and showed that GPs are still concerned with issues that will
        distract their focus from patient care.

          Consistent with our previous report,
          34% of GPs expressed a high level of job
          satisfaction. One in five (20%) say their job
          satisfaction is low or very low.

                                                                                                                                                   7

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The Aviva Health of the Nation Index - Spring 2012
The impact of technology
         The internet has had a major impact on culture and
         commerce and this effect is rapidly extending into healthcare.
         GPs responding to our survey now say that online tools, such
         as internet search engines and NHS Direct, are useful to
         patients to understand and diagnose their conditions as well
         as to manage their health and wellbeing.

         Understanding and diagnosing conditions
         In the past patients tended to receive most of their information from friends, family and newspapers but now,
         with the rise of the internet, GPs say that, internet search engines (49%) and NHS Direct (43%) are the top two
         information sources. Family (36%) and friends and colleagues (31%) remain important sources of information
         for patients in understanding and diagnosing their conditions. The global rise in the use of technology has also
         seen online media outlets (35%), smartphone apps (13%) and social media (9%) all growing in importance, with
         newspapers and magazines (18%) being seen as less useful.

         Our research reveals an age variation (shown in the graph below) regarding new media, with a significant split
         between those under 55 and those over 55 years of age. Interestingly, it is those GPs over 55 years of age that are
         more inclined to think that new technology tools, such as internet search engines (79%) and NHS Direct (67%), are
         useful to patients than those under 55 years of age.

            Which tools do you think are useful to patients in understanding or diagnosing their conditions?
                                     80%
                                                  79%                                                                                                                                                                                              Internet search engines
                                                                                                                                                                                                                                                   NHS Direct
                                     70%
                                                                                                                                                                                                                                                   Friends/colleagues
                                                                           67%
                                                                                                                                                                                                                                                   Magazines and newspapers
                                     60%                                                                                                                                                                                                           Family
                                                                                                                                                                                                                                                   Online media outlets
        Percentage of GPs surveyed

                                     50%                                                                                                                                                                                                           Social media
                                                                                                                                                                                                                                                   Patient driven content
                                                              47%
                                     40%                                                                46%                                                                                                                                        Smartphone health apps
                                                                                          40%                                                                             39%
                                     30%                                                                                                                                                            35%
                                                                                                                     32%          31%                        31%

                                     20%

                                                                                                                                                18%                                    18%
                                     10%                                                                                                                                                                        15%                        15%
                                                                                                                                                                                                                                                                                13%
                                                                                                                                                                                                                                                        10%
                                                                                                                                                                                                                              9%
                                                                                                                                                                                                                                                                   5%
                                      0%
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         8 The Aviva Health of the Nation Index

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The Aviva Health of the Nation Index - Spring 2012
“People are interested in
                     managing their own health and
                     the growth of the internet offers
                     a new way for them to engage
                     in self-care. Our survey shows
                     that GPs are generally supportive
                     of these new sources of patient
                     information. It’s also interesting
                     to see how telehealth will be
                     implemented in the future.
                     It promises much in terms of
                     improved patient satisfaction;
                     opportunities for self-care and
                     savings for healthcare systems.”
                   Dr Doug Wright, head of clinical development, Aviva, UK Health

        Managing health and wellbeing -                                                                     Which of the following do you think are useful
        GPs’ views on telehealth                                                                            to patients in managing their health and wellbeing?
                                                                                                                     8%
        The Government is keen to demonstrate how technology
        can support people to live independently, take control and                                                 14%                 Internet search engines
                                                                                                                           40%
        be responsible for their own health and care. The telehealth                                            16%
                                                                                                                                       NHS Direct
        services are a prime example of this. The initial findings from                                       18%                      Family
        the Government sponsored major study into telehealth show                                                                40%   Friends/colleagues
                                                                                                             20%
        that it can substantially reduce mortality; reduce the need for                                                                Media outlets like NetDoctor
                                                                                                                                       Magazines and newspapers
        admissions to hospital; lower the number of bed days spent in
                                                                                                               27%                     Patient driven content
        hospital and reduce the time patients spend in accident and                                                          40%       or commentary online
        emergency departments3.                                                                                      37%               Smartphone health apps
                                                                                                                                       Telehealth services
        However, the GPs we surveyed were not so enthusiastic about the                                                                Social media like twitter
        prospects for telehealth. When questioned about the tools they
        think are useful to patients in managing their health and wellbeing
        only 14% of GPs selected telehealth. GPs thought that internet
        search engines (40%), NHS Direct (40%) and family (40%) were
        the most use to patients in managing their health and wellbeing.

        3
            Department of Health. Whole System Demonstrator Programme Headline Findings – December 2011.

                                                                                                                                                                       9

34297_GEN4421_BRO.indd 9                                                                                                                                              04/04/2012 19:57
The Aviva Health of the Nation Index - Spring 2012
GPs’ views on the
         NHS reforms
         The Government’s plans for NHS reform have evoked widespread concern.
         As a result, the Prime Minister launched a ‘listening exercise’ which
         encouraged patients, professionals and organisations to come forward
         with suggestions to improve the Government’s proposals for the NHS.

         Following an 8 week engagement exercise, a number of changes were made to the Health and Social Care Bill. For example, the pace of the
         reforms has slowed and other clinicians, as well as GPs, will now be involved in making local decisions about the commissioning of healthcare.

         In our last Health of the Nation survey, we asked GPs their thoughts before this listening exercise took place and discovered there
         was much resistance to the proposed NHS reforms. Our survey this time finds that the Government’s listening exercise, carried out by
         the NHS Future Forum, has reduced GPs’ anxieties about the proposals – 32% of GPs now say they have no confidence in the plans
         compared to 51% in our last survey. However, although GP opinion has shifted significantly over the year there is still an overall lack
         of confidence in the plans for NHS reform. Moreover, over a third of GPs (35%) still feel that the reforms will destroy the NHS.

         Interestingly, older GPs tend to have more confidence in the revised plans for clinical commissioning groups. Whereas nearly half
         (48%) of GPs aged over 55 years had some confidence in the plans, only one in five (19%) of GPs under the age of 55 say they
         have confidence in the plans. There’s also significant regional variation – while only 11% of GPs in the South West of England have
         confidence in the plans that figure increases to 56% in the North West. Ultimately, however, all areas of England will be covered by
         clinical commissioning groups, but from April 2013 only those authorised by the NHS Commissioning Board will have full powers to
         commission, or buy, services for their local populations.

            Overall, how do you feel now about Government plans for clinical commissioning groups?
                                     60%
                                             60%
                                                                                                 I think this will not yield the                       I think it cannot work unless we
                                                                                                 savings the Government plans                          are given sufficient training to
                                                                                                                                                       adapt to the changes
                                                                                                 I think this will destroy the NHS
                                     50%                                          51%                                                                  Depends, I think their plans will
                                                                                                 I have no confidence                                  make a difference for some issues
                                                                                                 whatsoever in their plans
                                                                                                                                                       I have some confidence mixed with
                                                                                                 I think this is a bold reform, but     44%            reservations in the proposed plans
                                     40%             44%     44%                                 don't feel equipped to deliver it
        Percentage of GPs surveyed

                                                                       35%
                                     30%                                                                            33%                            33%
                                                                                             32%

                                                                                                         26%                   26%
                                     20%
                                                                                                                                                                                   22%

                                     10%                                                                                                                                 14%
                                                                                                                                                              12%

                                      0%
                                             10

                                                     11

                                                             10

                                                                       11

                                                                                  10

                                                                                             11

                                                                                                         10

                                                                                                                    11

                                                                                                                               10

                                                                                                                                        11

                                                                                                                                                   10

                                                                                                                                                              11

                                                                                                                                                                         10

                                                                                                                                                                                   11
                                             TN

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                                           HO

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                                                              Findings from Health of the Nation 2010 (HOTN 2010) compared to Health of the Nation 2011 (HOTN 2011)

         10 The Aviva Health of the Nation Index

34297_GEN4421_BRO.indd 10                                                                                                                                                                   04/04/2012 19:57
32% of GPs have no confidence
          in the Government’s plans for
          clinical commissioning. This
          compares to 51% of GPs
          in our previous report.

        Are GPs ready to implement clinical                                 Under the new plans for clinical commissioning
        commissioning?                                                      groups, which of the following best reflects how
        Our survey shows that there’s also concern about whether            you feel your life as a doctor will change?
        GPs are ready to implement the changes to the commissioning                       1.5%
                                                                                                             I will find my work load increases
        landscape, with around one in four (26%) saying that they
                                                                                         4%                  My stress levels will increase –
        don’t feel equipped to deliver clinical commissioning and the               6%                       I was trained for patient care not
                                                                                                             management
        same number thinking the reforms cannot work unless GPs are                                    27%
                                                                              9%
                                                                                                             I will find my focus moves away
        given sufficient training to adapt.                                                                  from patient care – onto admin
                                                                                                             I will find it harder to devote
        Moreover, GPs have concerns that their working life will change                                      enough time to my patients
        for the worse as the reforms are implemented. This is a view          16%
                                                                                                             I will have more opportunities to
                                                                                                             get the best service for my patients
        consistent with our last report. Over a quarter (27%) say that
                                                                                                             I think I will be able to offer my
        their workload will increase and 23% think that their stress                             23%         patients better access to care
        levels will go up. These views represent a feeling amongst many                                      I will feel more in control
        GPs who believe that they were trained for patient care not NHS
        management.

        Rather worrying is the finding that only 6% of GPs say the           Just 4% of GPs think that
        reforms will give them more opportunities to get the best service
        for patients. Whereas only 4% say that they’ll be able to offer
                                                                             clinical commissioning will
        patients better access to care. Again, this runs counter to the      enable them to give their
        Government’s rationale for NHS reform which is to shift
        decision-making as close as possible to individual patients.
                                                                             patients better access to care.

                                                                                                                                               11

34297_GEN4421_BRO.indd 11                                                                                                                      04/04/2012 19:57
Quality of NHS services
        Over the past few years, the NHS has become much more focused
        on tackling the main causes of premature mortality such as
        cardiovascular disease and cancer. The treatment of conditions
        such as heart disease in the NHS has changed dramatically in recent
        years – there is now an established trend of fewer deaths, improved
        access to services and wider adoption of improved treatments.

        These improvements have taken place against a backdrop of substantial investment in the NHS overall with funding
        doubling from 1999 to £103 billion per annum in 2010. However, the financial picture for the future is not looking
        so good. The NHS is currently being challenged by its Chief Executive, Sir David Nicholson, to find £20bn of efficiency
        savings by 2015. It remains to be seen exactly what impact this will have on services.

        Our survey shows that GPs recognise the good progress made for the treatment of cardiovascular disease, cancer
        and stroke. GPs say their local NHS Trusts now provide good services for patients with these conditions, but also
        for other conditions including asthma, flu and cataract surgery. Indeed the perceptions of how NHS Trusts are
        performing in these three areas have all improved since our 2011 report.

                                                                What kind of service do you currently feel that your local NHS
                                                                Trust provides for patients with cancer, heart disease and stroke?
                                                                                         60%
                                                                                                  Cancer
                                                                                                                                            57%
                                                                                                 Heart disease                        55%
                                                                                               36%
                                                                                                 Stroke services
                                                                                         50%                                    51%
                                                                                                                                                   50%
                                                            Percentage of GPs surveyed

                                                                                         40%                        41%   42%

                                                                                         30%

                                                                                         20%

                                                                                         10%

                                                                                                               7%

                                                                                                 3%     1%
                                                                                         0%
                                                                                                        Poor          Adequate              Good

        12 The Aviva Health of the Nation Index

34297_GEN4421_BRO.indd 12                                                                                                                                04/04/2012 19:57
Macmillan Cancer
                                                                                                                                                   Support says that
                                                                                                                                                   median survival
                                                                                                                                                   rates for all cancers
                                                                                                                                                   have increased by
                                                                                                                                                   1.5 years from 2001
                                                                                                                                                   to 20064 while over
                                                                                                                                                   a similar period the
                                                                                                                                                   number of deaths
                                                                                                                                                   from heart disease
                                                                                                                                                   fell by almost 30%.5

         There are signs of encouragement but there are still improvements to be made
         However, many of the GPs taking part in our survey still feel that the NHS is letting a number of patients down in
         its quality of care. Our survey reveals that GPs say services provided by their local NHS Trust are generally poor for
         the same conditions which they say are showing an increase. These include stress and anxiety, alcohol and drug
         addiction, depression, mental health issues and obesity.

         That said, it’s encouraging that for all of these conditions (with the exception of obesity and childhood obesity)
         that there have been some signs of improvement in GPs’ views of the services since our last report. Indeed the
         Government detailed its commitment to improving mental health services in its strategy ‘No health without mental
         health’ published in February 2011. We discuss the UK’s health trends in more detail on page 16 of this report.

            What kind of service do you currently feel that your local NHS Trust provides for patients
            with the following conditions?

                                                                                                                                                                          Alcoholism & drug
                                     60%                                                 60%
                                                                                                                                                                          addiction
                                                                                                    57%
                                                                                                                                                                          Depression
                                                                                                                                 55%                                      Mental health issues
                                                                                                                                                                          (excluding stress)
                                     50%                                                                      51%
                                                                                                                          49%                                             Stress & anxiety
                                                                                  48%
                                                                                                                    47%
        Percentage of GPs surveyed

                                                          46%                                                                                                             Alzheimer’s and
                                                                                                                                       45%
                                                                                                                                                                          dementia
                                     40%
                                                 40%
                                                                 41%                                                                                                      Obesity
                                           38%                                                                                               38%                          Childhood obesity

                                     30%
                                                                         31%

                                     20%

                                                                                                                                                                            14%
                                     10%
                                                                                                                                                                   10%
                                                                                                                                                         9%
                                                                                                                                                              7%                    7%
                                                                                                                                                    5%
                                      0%                                                                                                                                                 2%

                                                                Poor                                                  Adequate                                     Good

         4
                    Macmillan Cancer Support. Living After Diagnosis: Median Cancer Survival Times.

         5
                    Office for National Statistics. Death registrations in England and Wales, 2003 & 2009.

                                                                                                                                                                                                 13

34297_GEN4421_BRO.indd 13                                                                                                                                                                        04/04/2012 19:57
Difficulty making referrals
                                                                         Top 10 conditions for which GPs are having difficulty
         GPs were also asked about any difficulties
                                                                         in making referrals
         they have making referrals. As with last
                                                                                                                      1. Chronic fatigue syndrome
         year’s survey, GPs told us that they were still
                                                                                                                      2. Food allergies
         struggling to refer patients to treatment for                                 29%      46%
         conditions such as chronic fatigue syndrome,                                                                 3. Eating disorders
                                                                              31%
         eating disorders and food allergies. The severe                                                              4. Mental health issues in teenagers
                                                                                                      42%
         funding restraint in the NHS means that these                     33%                                        5. Learning and behavioural
                                                                                                                         difficulties in children
         difficulties are likely to continue.
                                                                           37%                          40%           6. Obese children
                                                                                                                      7. Mental health issues in children
                                                                                 37%              40%                 8. Back pain
                                                                                          37%
                                                                                                                      9. Work related stress
                                                                                                                      10. Obesity

         What would improve patients’ experiences of the NHS?
         As in previous years, we asked GPs again what they thought would improve their patients’ experiences of the NHS. Top of the list of
         their answers was longer appointments with GPs (55%) followed by shorter waiting lists (43%) and faster, more reliable diagnostic
         services (43%). A surprising finding was that only 8% of GPs said that greater choice for patients and GPs over where and by whom
         patients are treated would improve patients’ experiences of the NHS.

            Which of the following do you think would most improve your patient’s experience of the health service?
                                     60%
                                                                                                              Longer appointments with GPs

                                           55%                                                                Shorter waiting lists
                                     50%                                                                      Faster, more reliable diagnostic services
                                                                                                              More nurses/clinical support staff
                                                                                                              Improving clinical care by hospital doctors
                                     40%         43%   43%                                                    Removal of the ‘postcode lottery’
        Percentage of GPs surveyed

                                                                                                              Improved access to health information/education
                                                                                                              Better technology (IT and communications)
                                     30%                                                                      Better links with other primary care facilities
                                                                                                              Greater choice over where patients are treated
                                                                                                              Longer practice opening hours
                                     20%                                                                      Quicker/easier access to prescriptions
                                                             21%                                              Being called service-user, rather than patient
                                                                   18%     18%      17%                       Better access to high tech drugs e.g. cancer drugs

                                     10%
                                                                                                11%     10%
                                                                                                              8%
                                                                                                                          5%          2%       1%         1%
                                      0%

         14 The Aviva Health of the Nation Index

34297_GEN4421_BRO.indd 14                                                                                                                                       04/04/2012 19:57
The NHS in the future
         A controversial question in this year’s survey asked GPs which conditions they thought would not be covered by
         the NHS in the future. GPs ranked infertility (30%), ME (30%) and food allergies (28%) as being the most likely
         treatments to be excluded from the NHS within the next 5 years. Many people are worried that in trying to make
         significant efficiency savings, services which are perceived as low importance to the NHS will be sliced away and that
         the comprehensive nature of the NHS could be lost.

            Do you think that the NHS will no longer cover services for any of the following conditions in the future?
                                     30%
                                                                                                                          ME/chronic fatigue
                                           30%     30%
                                                                                                                          Infertility
                                                                28%                                                       Food allergies
                                     25%
                                                                                                                          Stress
                                                                                                                          Irritable bowel syndrome
                                                                                                                          Obesity
                                     20%
        Percentage of GPs surveyed

                                                                             21%                                          Continue to cover all of these services
                                                                                          20%                             Obesity issues in children
                                                                                                                          Eating disorders
                                     15%                                                                                  Mental health issues amongst children and young adults
                                                                                                                          Learning /behavioural difficulties in children
                                                                                                                          Depression
                                     10%                                                               12%    12%         Knee replacements
                                                                                                                    11%
                                                                                                                          9%            9%

                                     5%
                                                                                                                                                6%
                                                                                                                                                            5%
                                                                                                                                                                       3%
                                     0%

         Although NHS guidelines say that women should be able to access three cycles of infertility treatment on the NHS,
         many areas have suspended these services6, which might help explain our survey findings. Another interesting
         statistic from this survey was the finding that only 12% of GPs believe that all the services mentioned – from
         infertility treatments through to knee replacements – will still be provided by the NHS in 5 years time. This relatively
         low number could be related either to the impact of the efficiency savings or because GPs think that the NHS
         currently provides too many services, some of which should be stopped.

         6
                  Department of Health. Letter from Deputy NHS Chief Executive to all PCTs 11 January 2011.

                                                                                                                                                                            15

34297_GEN4421_BRO.indd 15                                                                                                                                                   04/04/2012 19:57
UK health trends
        As a leading private health insurance provider, we’re keen to track the UK’s
        health trends. To help us do this, we asked GPs whether they’re seeing an
        increase in the number of patients reporting specific conditions. Our findings
        have remained fairly consistent over the past eleven years – this year’s no
        different. However, what’s interesting and indeed worrying, is that our
        survey reveals that GPs feel that the services provided by their local NHS are
        generally poor for the same conditions which are becoming more common.

                                                  The GPs taking part in our Health of the Nation study once
                                                  again reported an increase in the number of patients that they’re
                                                  seeing with mental health issues. Around four in five (79%) GPs
                                                  reported an increase in patients with stress and anxiety – making
                                                  it the condition that the highest proportion of GPs say has
                                                  experienced growth in patient numbers over the past year.

                                                  Our research also reveals that GPs are seeing an increase in the
                                                  number of patients with alcoholism and drug addiction (41%),
                                                  mental health issues other than stress and anxiety (30%) and
                                                  Alzheimer’s and dementia (38%).

                                                  However, it’s not just mental health issues that are increasing.
                                                  With just over two in five (43%) GPs reporting an increase in the
                                                  number of obese patients that they’ve seen over the past year,
                                                  obesity proves to be the second most popular answer with GPs.

                                                  Looking into the future GPs expect stress (including work related)
                                                  and obesity to be the biggest health issues they will treat this year.

        16 The Aviva Health of the Nation Index

34297_GEN4421_BRO.indd 16                                                                                            04/04/2012 19:57
Have you noticed an increase in patients reporting any of the
        following conditions in the past year?

                              Stress / anxiety                                                                          79%

                                      Obesity                                                    43%

             Alcoholism and drug addiction                                                   41%

                  Dementia and Alzheimer’s                                                 38%

                                    Diabetes                                        31%

        Mental health issues excluding stress
                                                                                29%
           and anxiety e.g. bi-polar disorder

                   Irritable Bowel Syndrome                                   27%

                 Musculoskeletal conditions                               24%

              ME/Chronic Fatigue Syndrome                               22%

                          Childhood obesity                             21%

                                      Cancer                      15%

                                     Arthritis                  14%

                                   Migraines                    14%

           Children with learning difficulties                  13%

                                    Infertility             11%

               Sexually transmitted diseases                11%

                             Eating disorders              10%

                                           Flu             10%

             People wanting to get healthy/                9%
                     wanting health advice

                               Heart disease               8%

                                     Asthma           6%

                  Seasonal affective disorder         5%

                                       Stroke          3%

                                                  0             10       20           30         40    50     60   70         80
                                                                                 Percentage of GPs surveyed

                                                                                                                                   17

34297_GEN4421_BRO.indd 17                                                                                                          04/04/2012 19:57
A focus on public health
        In 2011, the Government launched its Public Health
        Responsibility Deal to tackle obesity and other public health
        issues. The deal states that “everyone has a part to play in
        improving public health, including Government, business,
        non-governmental organisations, and individuals themselves.”7

        The Government has committed to a reformed public health
        system in which local authorities take on new responsibilities
        for improving public health from 2013/2014. Our survey shows
        deep concerns among GPs that local authorities are ill-equipped
        to deal with the challenge. Over a third (34%) fear that public
        health will suffer as a result and a similar number (36%) predict
        a widening in regional variations in health and wellbeing.

        Which of the following reflect how you feel
        about the Government’s plans for public health?
                                                               Public health issues could become
                           10%                                 political
                     10%
                                        41%                    Local authorities are currently ill
                                                               equipped to deliver public health
               24%                                             Regional variations will become
                                                               much wider
                                                               Public health will suffer in the short term
                                                               Other health professionals should
              34%                              40%             have a greater role
                                                               Government's plans will make no
                                                               difference
                              36%                              Local authorities are well placed to
                                                               deliver public health

        Our survey also asked GPs which condition they felt would
        be the biggest public health issue in the coming year. Not
        unexpectedly, obesity proved to be the most popular response
        (40%), given that the latest NHS data shows that almost a
        quarter of adults in England are obese8. This was followed by
        stress (28%) and drug and alcohol abuse (16%). We explore the
        issues of obesity and mental health (including stress) in more
        detail on pages 22-29 of this report.

        7
            Department for Health. The Public Health Responsibility Deal. March 2011.

        8
            NHS Information Centre. Statistics on Obesity, Physical Activity and Diet: England, 2011

        18 The Aviva Health of the Nation Index

34297_GEN4421_BRO.indd 18                                                                                    04/04/2012 19:57
“GPs are sending out a clear message - we
                                                                          all need to be a lot more responsible for our
                                                                          own health as well as that of our children.
                                                                          We mustn’t forget that today’s children are
                                                                          the adults of tomorrow and if behaviours
                                                                          don’t change, the public health issues
                                                                          we’re seeing – and associated illness such
                                                                          as diabetes and breathing difficulties, will
                                                                          continue to increase the burden on the NHS
                                                                          and the economy.
                                                                        	It’s important that people can access the
                                                                          right support, education and incentives to
                                                                          encourage them and their families to lead
                                                                          a healthy lifestyle.”
                                                                        Dr Doug Wright, head of clinical development, Aviva, UK Health.

          Which condition do you think will be the biggest public                                  Are GPs equipped to help patients
          health issue over the next year?                                                         lead a healthy lifestyle?
                                     40%                                                           We also asked GPs whether they feel equipped to help
                                           40%                     Obesity
                                                                                                   their patients lead a healthy lifestyle and combat the
                                                                   Stress (incl work related)
                                                                                                   rise in obesity, work related stress and drug and alcohol
                                     35%                           Drug & alcohol abuse
                                                                                                   abuse. Interestingly, the majority of GPs (50%) pointed
                                                                   Tobacco related illness
                                                                   Influenza                       out that public health is everyone’s responsibility, not
                                     30%
                                                                   Antibiotic resistance           just GPs. Others said that they did feel equipped to
        Percentage of GPs surveyed

                                                 28%               Sexually transmitted diseases   help patients, but:
                                     25%                           Teenage pregnancy
                                                                                                   l   43% said the onus should be on the individual to
                                                                                                       lead a healthy lifestyle
                                     20%
                                                                                                   l   39% said helping patients lead healthy lifestyles is part of
                                     15%               16%                                             their role and interlinked with general health problems

                                                                                                   l   38% said patients don’t follow their advice; and
                                     10%
                                                                                                   l   23% said often patients are not truthful about their
                                                                                                       lifestyle, which makes it hard to advise.
                                     5%
                                                             4%                                    These results confirm that public health is everybody’s
                                                                                             1%
                                                                  2%    2%        2%               business and improving it will take more than just
                                     0%
                                                                                                   relying on GPs.

                                                                                                                                                                 19

34297_GEN4421_BRO.indd 19                                                                                                                                       04/04/2012 19:57
What is Aviva doing to help?
        Aviva’s ambition is not only to provide products to support our
        customers’ health, but to positively change peoples’ behaviours
        and attitudes to health through education and thought leadership.

        Our health insurance products include services, such as MyHealthCounts that
        not only helps people improve their health, but also rewards them with lower
        renewal premiums for doing so. We’re also working hard to encourage children
        to participate in sport through our athletics and rugby schools’ programmes.

        As supporters of the Government’s Change4Life programme, we’ve recently
        launched a new website Home of Health (www.aviva.co.uk/health-insurance/
        home-of-health/), designed to give customers practical health advice and support.
        The site includes information on nutrition, exercise training guides and health
        tools such as a BMI calculator and calorie counter.

        We also work closely with our corporate customers to help them instil a culture
        that pro-actively encourages health and wellbeing within their organisation.
        In addition, we offer a wide range of products and services designed to help
        employees improve their health.

        MyHealthCounts
        MyHealthCounts is an innovative health management service that encourages
        individuals to take pro-active steps to improve their lifestyle and rewards them
        with up to 15% wellness discount off their renewal premium for any positive
        impact their efforts have on their health.

        Designed by medical experts, MyHealthCounts contains a wealth of invaluable
        information including a health assessment tool, nutritional information and an
        online coach offering personalised advice on the steps individuals can take to
        improve their health and help reduce their risk of developing serious illnesses
        such as heart disease, stroke and cancer.

        Aviva has also arranged preferential rates for pharmacy health checks at over 600
        pharmacists across the UK. Customers simply book their appointment online and
        once they’ve visited the pharmacist, their results are automatically uploaded onto
        their MyHealthCounts account.

        20 The Aviva Health of the Nation Index

34297_GEN4421_BRO.indd 20                                                                    04/04/2012 19:57
Our involvement with sport

          We’ve been supporting British athletes                             We also run a rugby schools programme that
          since 1999 and are helping pave the way                            introduces tag rugby to 40,000 children per
          for their success by hosting six world class                       year across 650 schools. The programme is
          athletics events on home soil – the Aviva         Supporting       designed to build a legacy of trained teachers
                                                          British athletes
          Series 2012 - supporting the Aviva GB & NI         since 1999      who are able to deliver tag rugby in a way that
          junior, senior and disability teams as they                        meets the national curriculum. The schools programme is all
          prepare for all major championships. Through the Aviva             inclusive and encourages girls and boys of all abilities to get
          Athletics Academy, we are also providing the opportunity           involved. Anecdotal feedback suggests that this programme
          for the next generation to get involved in athletics.              helps to improve self-esteem and has encouraged children
                                                                             who have shied away from sport to take part.

                                                                                                                                               21

34297_GEN4421_BRO.indd 21                                                                                                                      04/04/2012 19:57
A focus on obesity
        The latest NHS data shows that almost a quarter of adults in England are
        obese, and 66% of men and 57% of women are overweight or obese9.
        A third of 10 and 11 year olds are overweight or obese10. Obesity, which
        is a major risk factor for diseases such as type 2 diabetes, cancer and heart
        disease, costs the NHS £5bn each year, and costs the wider economy much
        more. GPs believe that obesity will be the biggest public health issue over
        the next year, with 40% of GPs identifying it as a top concern.

        They also say that their local NHS Trusts have poor services                                         What do you think are the main causes of an increase
        for conditions such as obesity. This will be of concern to the                                       in childhood obesity?
        Government given the relentless rise in obesity and the impact it                                                   100%
        has on the NHS - admissions to hospital with a primary diagnosis                                                                                           Sedentary lifestyle
                                                                                                                                                                   Poor diet
        of obesity have risen more than 10 fold in the last decade11.
                                                                                                                                                                   Lack of parental support/guidance
                                                                                                                                           87%
                                                                                                                                                                   Ease of access to fast food
        A large number of GPs (43%) say that obesity is rising across                                                                80%
                                                                                                                                                                   Advertising aimed at children
        all age ranges. But there are regional variations in the numbers
                                                                                                                                                                   Lack of education re leading
                                                                                                        Percentage of GPs surveyed

        of GPs that agree with this overall trend, with GPs in Scotland                                                                          72%               a healthy lifestyle

        (75%) most likely to suggest that obesity is rising across all                                                                                             No increase in childhood
                                                                                                                                                       64%         obesity problems
                                                                                                                                     60%
        age ranges compared with only 25% in the East Midlands.                                                                                                    School pressures
        This variation in views reflects the regional differences seen in
        obesity rates, which show Scotland appearing at the top of the
                                                                                                                                                             45%
        league tables.                                                                                                               40%

        Perceived increases in childhood obesity are of particular
        concern. Our research shows:
                                                                                                                                     20%
        l      80% of GPs believe that there has been an increase in
                                                                                                                                                                     14%
               childhood obesity in the past five years                                                                                                                        9%        3%
                                                                                                                                                                                                   1%
        l      This is seen as due to a sedentary lifestyle (87%), poor diet                                                         0%
               (72%) and a lack of parental support (64%)

        l      70% of GPs believe that there has been an increase in the
               number of children with problems relating to obesity in the
               past year

        l      GPs have noted a commensurate increase in comorbidities
               among obese children including diabetes (40%), breathing
               difficulties (35%) and mental health issues (53%).

        9
            NHS Information Centre. Statistics on Obesity, Physical Activity and Diet: England, 2011

        10
             Department of Health

        11
             NHS Information Centre. Statistics on Obesity, Physical Activity and Diet: England, 2011

        22 The Aviva Health of the Nation Index

34297_GEN4421_BRO.indd 22                                                                                                                                                                          04/04/2012 19:57
Whose responsibility is it to tackle                                       Whose responsibility do you think it is to manage
        the obesity issue?                                                         the obesity issue amongst children?
        An overwhelming majority of GPs (81%) believe that it’s the                                        85%
                                                                                                                 84%                         Parents
        responsibility of individuals to manage obesity and few believe
                                                                                                                                             The Government/NHS
        that putting pressure on the food industry will yield results.                                                                       The makers of the products
        GPs in Scotland (95%) and the West Midlands (94%) are most                                                                           The supermarkets and
                                                                                                           68%                               restaurant chains
        likely to suggest that individual responsibility takes precedence.
                                                                                                                                             Schools
                                                                              Percentage of GPs surveyed

        On the issue of tackling obesity in children, the majority of
        GPs believe that it is parents’ responsibility to address it.                                      51%
        Our research shows that:

        l   Just 9% of GPs believe it is the responsibility of the
                                                                                                                            45%
            Government to manage obesity issues                                                            34%

        l   84% of GPs believe that it is the responsibility of parents to
            manage the obesity issue amongst children
                                                                                                           17%
        l   Only 1% of GPs believe it is the responsibility of supermarkets
                                                                                                                                       14%
            and restaurant chains to tackle adult obesity and only 2%
                                                                                                                       7%         2%             9%
            consider it to be food manufacturers’ responsibility.                                                                                 1%           1%
                                                                                                           0%

                                                                                                                                                                    23

34297_GEN4421_BRO.indd 23                                                                                                                                           04/04/2012 19:58
What can be done to tackle the obesity issue?                                                                                Top 10 initiatives which
        There’s little agreement amongst GPs on how we can tackle obesity. The                                                       would help to reduce obesity
        solution, as we know, is multifactorial and complex as confirmed by the findings
        of the Foresight Report on Tackling Obesity12. However, in line with GPs’ views                                                                43%      77%
        on individual and parental responsibilities, the most commonly-mentioned                                                                 45%
        solutions were parents teaching their children about healthy eating (77%) and
                                                                                                                                            46%                         74%
        families eating home cooked meals together (74%).

                                                                                                                                           46%
        What is the Government doing to tackle obesity?                                                                                                                  69%
        The Government published its ‘Call to action on obesity in England’ in                                                                 50%

        October 201113. It’s set itself challenging ambitions to be delivered before 2020:                                                             63%
                                                                                                                                                                 66%

        l      a sustained downward trend in the level of excess weight in children; and
                                                                                                                                      1. Parents teaching their children about
        l      a downward trend in the level of excess weight averaged across all adults.                                                healthy eating
                                                                                                                                      2. Families eating home cooked
        This will be achieved through empowering individuals with guidance                                                               meals together
        and encouragement backed by insights from behavioural science. The
                                                                                                                                      3. Better awareness of portion sizes
        Government will work in partnership with the food industry to reduce our
                                                                                                                                      4. Cheaper healthy food options
        collective calorie intake; and give a lead role to local Government giving it
                                                                                                                                      5. Better health education in schools
        freedom to determine the local approaches which work best. It will also
                                                                                                                                      6. Banning junk food in schools
        develop further the evidence base for effective interventions for tackling                                                       and workplaces
        obesity, and promote the spread of good practice and the use of evidence.
                                                                                                                                      7. Encouraging supermarkets to change
                                                                                                                                         their merchandising
                                                                                                                                      8. Banning advertising of unhealthy
                                                                                                                                         food during children’s programmes
                                                                                                                                      9. Improved education in schools about
                                                                                                                                         the benefits of exercise
                                                                                                                                      10. Incentives to increase participation in sport

        12
             Government Office for Science. Tackling Obesities: Future Choices – Project Report. 2nd edition. Foresight Programme.

        13
             Department of Health – Healthy Lives, Healthy People – A call to action on obesity in England (October 2011)

        24 The fifth Aviva Health of the Workplace Report

34297_GEN4421_BRO.indd 24                                                                                                                                                                 04/04/2012 19:58
Views on the Government’s initiatives to tackle obesity
         There are mixed views on the Government’s response to the obesity epidemic. 50% of GPs believe that the Government’s focus
         on individuals taking responsibility for their own health is the correct attitude. However, over a third (35%) of GPs believe that the
         policy measures announced do not go far enough and would like to see regulation of the food industry.

                                      50%
                                                   50%                                                  People need to take responsibilty for their own health
                                                                                                        The food industry needs regulation
                                                                                                        Government should have gone further compelling the food industry
                                      40%                                                               to cut back on salt, fat etc
                                                                                                        I am glad to see the Government starting to take this seriously
                                                                                                        I would have liked to see more focus on initiatives such as Change4Life
        Percentage of GP’s surveyed

                                                              35%                                       I would be in favour of fat tax to take these measures further
                                      30%
                                                                                                        Relying on personal responsibility to solve this crisis is naive
                                                                                                        People should be financially incestivised to take up exercise/sport
                                                                          27%                           I was pleased to see the public health budgets ringfenced
                                                                                       25%
                                                                                                        There is no need for the Government to focus on obesity
                                      20%

                                                                                                 17%        17%
                                                                                                                            16%
                                      10%

                                                                                                                                            6%             6%
                                                                                                                                                                           1%
                                        0%

         Between these two policy positions of individual responsibility and increased regulation, GPs supported a range of views:

         l                            27% said the Government should have gone further in forcing the food industry to cut back on salt, fat etc

         l                            25% said they were glad to see the Government starting to take this seriously, and

         l                            17% said they would be in favour of a fat tax.

         On a number of measures, obesity is going to be the key concern for the NHS in the coming years. GPs in our survey
         were sceptical about the Government’s proposals to deal with the issue and reverse a trend that has defied all previous
         attempts. However, there is no single answer to dealing with what is a complex problem made up of multiple cultural,
         sociological and individual factors.

         “Obesity is the leading cause of serious disease
           such as type 2 diabetes, heart disease and
           cancer. We must get to grips with the problem
           and saves lives and money in the future.”
         England’s Chief Medical Officer, Professor Sally Davies

                                                                                                                                                                                  25

34297_GEN4421_BRO.indd 25                                                                                                                                                         04/04/2012 19:58
A focus on mental health
         Over a quarter of GPs (28%) predict that mental health will be the biggest
         public health issue this year. Our survey reveals that GPs are witnessing
         an increase in patients of all ages with mental health conditions and feel
         that local NHS services are ill-equipped to deal with this problem. In this
         section, we explore in more detail the key trends GPs are seeing in their
         surgeries – particularly in relation to childhood mental health issues.

         Our survey reveals that there’s growing demand on GPs’ time from patients with mental health problems, with over three quarters (79%) of GPs
         saying they have noticed an increase in the number of patients reporting with mental health conditions and stress and anxiety. The Government
         is taking steps to address concerns with the publication of its cross-departmental mental health strategy, ‘No health without mental health’. Their
         aim is to ensure mental health becomes ‘mainstream’, so that it becomes both as important to and accepted by people as physical health14.

         However, GPs also say that childhood mental health is a growing problem, with a clear majority of them having noticed an increase
         in the number of young patients presenting with mental health problems in the past five years:

         l                           61% of GPs believe there has been an increase in the number of children (5-12 year olds) with mental health problems

         l                           78% of GPs believe there has been an increase in the number of teenagers (13-19 year olds) with mental health problems.

         We also asked GPs about the conditions that were causing the rise in mental health problems in children and teenagers. The top
         5 conditions ranged from behavioural issues (60%) through to addictive conditions (31%) revealing that children and teenagers
         suffer from a similar set of issues to adults.

            If you believe there has been an increase in either age group presenting in mental health
            problems, why is this?
                                     60%
                                                  60%                                                                                                     Behavioural issues
                                                                                                                                                          Anxiety
                                                                54%
                                     50%                                                                                                                  Depression

                                                                                  49%                                                                     Self-harm
                                                                                                                                                          Addictive conditions -
                                     40%                                                             44%                                                  e.g. drug and alcohol abuse
        Percentage of GPs surveyed

                                                                                                                                                          Eating disorders
                                                                                                                                                          There has not been an increase in mental
                                                                                                                                                          health problems in children and teenagers
                                     30%                                                                                                                  OCD
                                                                                                                       31%               30%              Psychosis

                                     20%

                                                                                                                                                          16%
                                     10%
                                                                                                                                                                         10%

                                       0%                                                                                                                                                4%

         14
                        HM Government. No health without mental health. A cross-government mental health outcomes strategy for people of all ages. 2011

         26 The Aviva Health of the Nation Index

34297_GEN4421_BRO.indd 26                                                                                                                                                                             04/04/2012 19:58
Childhood mental health issues
                                                                                          What’s causing the increase in mental health problems
        More interesting is the response from GPs on
                                                                                          in young people?
        the causes of the increase in mental health
        problems in children and teenagers. Our                                           1. Lack of parental support/guidance                                         52%
        research shows that GPs say the main causes
        are the lack of parental support (52%) and the                                    2. The home environment                                                      51%
        home environment (51%). Moreover, almost
                                                                                          3.	Greater awareness of mental health problems                              35%
        two-thirds (63%) of GPs believe that there’s still
        a stigma associated with mental health issues
                                                                                          4.	Lifestyle issues (e.g. drug and alcohol use)                             33%
        which stops parents bringing their children to
        see them – suggesting that the problem may be                                     5.	School pressures (bullying, exams etc)                                   30%
        more widespread than our research shows.

        The quality of service for                               What kind of service do you currently feel that your local
        children with mental health                              NHS Trust provides for patients with mental health issues?
        issues is poor
                                                                                            60%
                                                                                                      60%                                      Mental health issues
        Worryingly, GPs are unconvinced of the
                                                                                                                                               among teenagers
        quality of the services available to this                                                           56%                                (13-19 yrs)
                                                                                                                                             36%
        growing number of patients: 46% of GPs                                                                                                 Mental health issues
                                                                                            50%                                                among children
        consider local NHS mental health services to                                                                                           (5-12 years)
                                                                                                                                       47%
        be poor and only 7% say that these services                                                                46%                            Adult mental
                                                                                                                                                  health issues
                                                             Percentage of GPs surveyed

        could be described as good.                                                         40%                                                   (excluding stress)
                                                                                                                                 40%
        The findings for mental health services for
                                                                                                                           35%
        teenagers and children were slightly worse:
                                                                                            30%
        60% of GPs said their local NHS Trusts
        provided poor services for mental health
        issues among teenagers (13-19 years old)
                                                                                            20%
        whereas just over half (56%) said the same
        for services for children (5-12 years old).

                                                                                            10%

                                                                                                                                                             7%
                                                                                                                                             5%
                                                                                                                                                     4%
                                                                                             0%
                                                                                                            Poor               Adequate             Good

                                                                                                                                                                             27

34297_GEN4421_BRO.indd 27                                                                                                                                                04/04/2012 19:58
The use of antidepressants
         Our survey finds that almost two-thirds (65%) of GPs have
         prescribed antidepressants in situations where they felt that
         psychological therapies or better social care would be a more
         appropriate response. Of these GPs, 80% have done so due to
         the long waiting lists for mental health services.

             If you have prescribed drugs such as antidepressants
             when you felt that psychological therapies or better
             social care would be more appropriate, which of the
             following best explain why?

                                     80%
                                           80%               Long waiting lists for health
                                                             support
                                     70%                     Lack of support for GPs
                                                             in this area
                                                             Pressure from patients for drugs
                                     60%                     Pressure from parents to give
                                                             their children drugs
        Percentage of GPs surveyed

                                                             This is less costly and time
                                     50%                     consuming

                                                 47%

                                     40%

                                     30%

                                     20%

                                     10%               13%
                                                                       8%
                                                                                       3%
                                     0%

         Unsurprisingly, we found that a large number of GPs would like
         to see greater availability of psychological therapies for people
         with mental health problems and 28% consider this to be one
         of the most pressing priorities for the health service. Indeed,
         the Government has committed to increase the availability to
         psychological therapies by making additional funds available.

         28 The Aviva Health of the Nation Index

34297_GEN4421_BRO.indd 28                                                                       04/04/2012 19:58
“Mental health has always been
               seen as a Cinderella service in
               the NHS when compared to other
               services such as cardiovascular
               disease and cancer. But in this
               survey GPs say demand is growing
               and that the quality of some local
               NHS services is poor, especially for
               children and teenagers.
               Although GPs recognise the
               need for improving mental
               health services, funding
               constraints in the NHS will be
               challenging for the next few
               years, so the likelihood is that
               they will continue to be pushed
               to the back of the queue.”
                Dr Doug Wright, head of clinical development,
                Aviva, UK Health.

        What do you think about more widespread                               In terms of priority for the NHS, our survey shows that 64% of
        availability in the NHS of psychological therapies                    GPs agreed that a necessary expansion of mental health services
        for people with mental health difficulties?                           was required but felt that this is not a top priority in the current
                                                                              climate. However, almost a third (28%) of GPs disagreed with
                   5%                                                         this view saying that mental health is one of the most pressing
                                                                              priorities for the NHS.
                        2%                  A necessary expansion of
                                            services but not a top priority
          28%                               One of the most pressing
                                            priorities for the NHS
                                            Nice to have but not necessary
                                            An unnecessary use of
                              64%           NHS resources

                                                                                                                                                29

34297_GEN4421_BRO.indd 29                                                                                                                      04/04/2012 19:58
What does this mean?
        Our research highlights that GPs’ views remain as important as ever,
        especially as the NHS moves into a period of great financial and
        organisational uncertainty, and GPs will be at the heart of delivering the
        Government’s controversial NHS reforms. As in previous years, our research
        also highlights a number of areas where GPs think the NHS could improve
        services for patients. Examples include obesity and mental health.

        More time with patients
        One of the greatest concerns for GPs is the amount of time they spend with their patients – 55% said that this one simple measure
        would improve patients’ experiences of the NHS. But GPs say they are being prevented from spending quality time with patients by
        the persistent issue of too much paperwork and also having to deal with some patients who have unrealistic expectations of the NHS.

        It is a difficult balance for GPs, many of whom end up working long hours, and this work life balance could end up getting worse.
        Almost a third of GPs say their workload will increase and almost a quarter say that their stress levels will increase under the
        Government’s plans to introduce clinical commissioning groups. Relieving some of the pressures for GPs - so that they can ultimately
        spend more time with their patients - should be a priority for policymakers to consider.

        Improvements in services
        At a more general level GPs recognise the huge improvements that have been made in NHS services (such as cardiovascular disease
        and cancer) in recent years. However, they also recognise that there is still much for the NHS to do, especially with improving
        services for mental health: stress and anxiety; alcohol and drug addiction and depression.

        To compound this problem, these are the conditions which GPs say they are seeing more of in their surgeries. Stress and anxiety;
        mental health issues and problems with alcohol and drugs are all on the increase according to GPs in this survey. Whether the NHS
        has the resources to improve services in these areas remains doubtful with the combined distractions of NHS reform and meeting
        the £20 billion efficiency savings challenge.

        Continued concern about NHS reform
        The planned NHS reforms continue to dominate the headlines and many GPs remain concerned. 32% say that they have no
        confidence in the Government’s plans, although this is down from 51% in our last report. This shows that the listening exercise
        has helped to allay some fears among a number of GPs. It will be interesting to see if GPs’ views change further as the NHS reforms
        move off the drawing board and into implementation.

        Another aspect of the NHS reforms focuses on public health, with a bold vision for the creation of a new ‘wellness service’.
        But again, our survey shows that GPs are sceptical – 40% saying that local authorities are currently ill equipped to deliver the
        Government’s proposals. But with rising levels of obesity and mental health issues, such as work related stress, it is imperative that
        public health becomes a higher priority across the public and private sectors and that this is matched with dedicated resources.

        GPs are at the centre of the UK’s healthcare system and our research has highlighted their views as the NHS moves into a period of
        unprecedented change. There have been notable improvements in the nation’s health in recent years and GPs’ roles in maintaining
        this momentum will be critical. Future Health of the Nation reports will continue to act as a barometer of that progress.

        30 The Aviva Health of the Nation Index

34297_GEN4421_BRO.indd 30                                                                                                                    04/04/2012 19:58
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