Implications of skill-mix change in general practice: secondary analysis of data from the GP Patient Survey

The shift in policy and practice towards multiprofessional team working has potential implications for patients' experience.

To examine the relationship between delivery of care and patient-reported confidence and trust, and perception of needs met.

Secondary analysis of data from the GP Patient Survey (2023), including 759 149 responders from 6418 English general practices.

Multivariable logistic regression was used to investigate the association between primary outcomes (confidence and trust, and perception of needs met) and patient characteristics, as well as to explore relationships with different combinations of type of health professional and mode of appointment.

When patients are uncertain what type of health professional their appointment was with, odds of expressing confidence and trust decreased by 50%-80% compared with those who saw a GP at their practice. A 50% decrease in the odds of reporting confidence and trust was associated with speaking to a health professional on the phone or by video (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] = 0.55 to 0.57 and aOR 0.48, 95% CI = 0.42 to 0.55, respectively), compared with patients whose appointment was at their general practice in person. Similar trends were observed for patient-reported needs met.

Patients who were confused who their general practice appointment was with experienced lower trust and were more likely to perceive that their needs were not met. The impact was magnified when the consultation was remote (phone, video, or message). Helping patients understand new roles and providing clarity on who the patient is seeing are essential for building patient confidence in new models of care.