Do More Appointments Lead to Shorter Waits and Better Patient Experience? A Retrospective Observational Study of NHS Primary Care
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Introduction
Primary care productivity and performance are hard to measure because patient health is not measured systematically and consistently. In England, productivity is measured using output (appointment volume) and two value-based metrics: waiting times and patient satisfaction. Higher productivity should improve all these metrics: more appointments should shorten waits, and shorter waits should raise patient satisfaction. However, little evidence tests how output and value-based metrics are associated.
Methods
We conducted a retrospective observational study of NHS primary care in England, 2018 to 2024, using Appointments in General Practice and the GP Patient Survey. Across Integrated Care Boards (ICBs), we examined the relationship between changes in appointment volume, waiting times, and patient dissatisfaction over two periods, 2018-2022 and 2022-2023, stratified by staff group and appointment mode.
Results
Completed appointments rose between 2018 and 2024, with care shifting towards non-GP staff and virtual delivery. Across ICBs in 2018-2022, per million additional appointments, waiting time changed by -0.04 days (95% CI: -0.10, 0.03) and dissatisfaction by 0.02 percentage points (95% CI: -0.36, 0.40). Per additional day of waiting, dissatisfaction changed by -1.40 percentage points (95% CI: -3.21, 0.42). In 2022-2023, the corresponding estimates were -0.31 days (95% CI: -0.57, -0.04), -0.75 percentage points (95% CI: -3.05, 1.56), and 2.85 percentage points (95% CI: 1.20, 4.51).
Conclusion
Increased appointment volume was not associated with shorter waiting times or lower patient dissatisfaction, and shorter waiting times were not associated with lower patient dissatisfaction. Either quality metrics do not respond to output, the key factor providers control, or they do not capture the dimensions of quality that matter. Performance frameworks that assess primary care productivity through these metrics should be reviewed.
Key Messages Box
What is already known on this topic
In England, primary care productivity is assessed using appointment volume alongside waiting times and patient satisfaction as quality adjustments. However, waiting times reflect demand as well as supply, and patient satisfaction is shaped by continuity, case mix, and patient characteristics beyond provider control. A common assumption is that increases in appointment volume lead to shorter waiting times and higher patient satisfaction, but this link has not been tested directly.
What this study adds
This is the first direct test of the output-quality relationship in NHS primary care: using national data from 2018 to 2024, output growth was associated with neither shorter waiting times nor lower patient dissatisfaction, and shorter waiting times were not associated with lower patient dissatisfaction.
How this study might affect research, practice or policy
Performance frameworks that evaluate primary care productivity through their impact on waiting times and patient satisfaction should be reviewed, with future research establishing what drives appointments, access, and satisfaction and whether these metrics reflect genuine improvements in patient health.
