The Aviva Health of the Nation Index - Spring 2012
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The Aviva Health
of the Nation Index
Spring 2012
34297_GEN4421_BRO.indd 1 04/04/2012 19:57
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.
34297_GEN4421_BRO.indd 2 04/04/2012 19:57
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
34297_GEN4421_BRO.indd 3 04/04/2012 19:57
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
34297_GEN4421_BRO.indd 4 04/04/2012 19:57
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
5
34297_GEN4421_BRO.indd 5 04/04/2012 19:57
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
34297_GEN4421_BRO.indd 6 04/04/2012 19:57
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
34297_GEN4421_BRO.indd 7 04/04/2012 19:57
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%
e
e
e
e
e
e
e
e
e
e
e
e
e
e
e
e
e
e
rag
rag
rag
g
rag
rag
rag
rag
rag
rag
rag
rag
rag
rag
rag
rag
g
rag
era
era
ve
ve
ve
ve
ve
ve
e
ve
ve
ve
ve
e
ve
ve
ve
ve
av
av
av
av
5a
5a
5a
5a
5a
5a
5a
5a
5a
5a
5a
5a
5a
5a
55
55
55
55
r5
r5
r5
r5
r5
r5
r5
r5
r5
r5
r5
r5
r5
r5
r
r
er
er
e
de
e
de
e
de
e
de
e
de
e
de
de
e
de
de
Ov
Ov
Ov
Ov
Ov
Ov
Ov
Ov
Ov
Un
Un
Un
Un
Un
Un
Un
Un
Un
8 The Aviva Health of the Nation Index
34297_GEN4421_BRO.indd 8 04/04/2012 19:57
“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
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
TN
TN
TN
TN
TN
TN
TN
TN
TN
TN
TN
TN
TN
HO
HO
HO
HO
HO
HO
HO
HO
HO
HO
HO
HO
HO
HO
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 19:5732% 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 19:57Quality 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 19:57Macmillan 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 19:57Difficulty 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 19:57The 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 19:57UK 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 19:57Have 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 19:57A 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 19:57What 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 19:57Our 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 19:57A 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 19:57Whose 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 19:58What 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 19:58Views 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 19:58A 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 19:58Childhood 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 19:58The 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 19:58What 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
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