Fixing the front doors? Public perceptions of the NHS and general practice

Labour’s 10-Year Health Plan aims to focus the NHS on expanding community care, making greater use of technology, and doing more to prevent illness. These shifts receive broad public support – but the ambitions themselves are not new and there is limited detail on what they mean in practice. Meanwhile, resources to deliver them are constrained.

Shifting more care out of hospital and into community settings is a central part of the government’s reform agenda. The flagship ‘neighbourhood health service’ aims to deliver more proactive, coordinated care to frail patients with multiple long-term conditions, with the primary objective of reducing unplanned hospital admissions. But evidence from similar initiatives suggests realising the potential benefits will be difficult. 

In the meantime, general practice – the foundation of this shift – is under considerable strain, as practices struggle to meet demand for appointments and provide continuity of care for the patients who need it most. Pressures remain intense for other NHS services too, amplified by an early outbreak of flu in October 2025 and industrial action by resident doctors in England in October and December. While the government has hailed recent reductions in waiting lists for planned surgery, projections of recent trends suggest the NHS is set to fall short of delivering the pledge to restore the 18-week standard by 2029.

Before November’s Autumn Budget, there was substantial speculation that the Chancellor would break Labour’s manifesto pledge not to raise headline tax rates on working people to avoid a return to austerity for public services, but ultimately that decision was not taken. While a £300m investment in digital infrastructure was welcomed at the budget, the NHS is still working within a tight financial settlement that requires some difficult decisions. 

Today, 18 months into the new government, how well does the public think it is responding to the challenges in primary care and hospitals? 

To answer this, we undertook the ninth wave of our 6-monthly public perceptions research programme with Ipsos, which aims to understand how the UK public’s attitudes to health and social care are changing. For the first time, our survey includes a deep dive on general practice, exploring attitudes to access, AI, GP earnings and practice ownership.

The research took place during 4–10 December 2025 and surveyed 2,214 people aged 16 years and over using Ipsos’s UK KnowledgePanel (see Survey methods). This was after the Autumn Budget and between the two periods of resident doctors’ strike action.

What do people think about NHS standards of care?

Since the 2024 election, our polling has shown a decline in pessimism under the Labour government. This survey shows 42% of the public thinks that the general standard of NHS care worsened over the past 12 months, slightly more than in our survey 6 months ago (38%), while only 12% believe it got better. 

People who have a health problem or disability (51%) or used urgent and emergency care (49%) in the past 12 months are more likely to think that standards fell. By contrast, people with recent experience of non-emergency hospital services are more likely (16%) to think that standards improved (though still negative overall).¹ 

People are similarly pessimistic about prospects for the year ahead. 47% think standards will decline (up from 41% in May 2025) and 15% say they will rise. People who used non-emergency hospital services in the past 12 months (21%) are more optimistic that standards will get better but still negative overall.

While expectations have become slightly more pessimistic over the past 6 months, the public’s views on how the NHS is currently performing are unchanged. Experiences of local NHS services continue to be substantially more positive than views on the NHS as a whole. 47% agree that they receive a good service from the local NHS, with 30% disagreeing. People who used non-emergency hospital services are among the most positive about the service they receive (57% agreeing). However, those with recent experience of urgent and emergency care are more likely to disagree (35%) that they are receiving good local NHS service. 

Perceptions of the national performance of the NHS are negative overall: only 32% agree the NHS provides a good service nationally, and 42% disagree. People intending to vote Labour (40%) or Green (42%) are more likely to agree. Those living in Northern Ireland (55%), or intending to vote Conservative (50%) or Reform UK (58%), are more likely to disagree. 

Views on government policies are unchanged from 6 months ago. 15% agree that the government in their nation has the right NHS policies, while 54% disagree. People living in Scotland (45%) and Wales (39%) are less likely to disagree, whereas those living in England (55%) and Northern Ireland (67%) are more likely to disagree. People intending to vote Labour (40%) are more likely to agree, whereas Conservative (64%) and Reform UK (81%) voters are more likely to disagree. 

Lack of funding and management criticisms are the most common views on causes of NHS pressures

The public believes that current NHS pressures are caused by several different factors. A lack of funding (37%), poor NHS management (36%) and lack of staff (29%) are top, but at least 1 in 5 of those surveyed identified people using services inappropriately, poor government policy, an ageing population, poor capacity in social care, and immigration.

Views are heavily linked to voting intention (Figure 1). For Labour and Liberal Democrat voters, the top three issues are a lack of funding, increased demand due to an ageing population, and a lack of capacity in the social care system. In contrast, Conservative and Reform UK voters attribute the current pressures to poor NHS management, people using NHS services inappropriately, and increased demand due to immigration. Green voters are more similar to the public overall, highlighting a lack of funding and staff and – tied in third – poor NHS management and government policy. 

Improving GP access is consistently a high priority for the public. But what should policymakers be aware of when shaping a coherent reform agenda to make this happen? And what other issues matter to the public to improve and reform general practice? Our survey provides a deep dive into public attitudes on the NHS service that people use most often.

Continued concern over GP access

The public continues to experience considerable challenges accessing general practice. In the past 12 months, just under half of people (48%) say they had a health concern that they thought of contacting their GP practice about but delayed doing so, or did not contact it at all. A greater percentage of women (56%), people aged 35–44 (58%) and people with a health condition or disability (60%) delayed or did not contact their practice. 

Some of the most common reasons people gave for not contacting their practice are linked to perceived problems with getting an appointment or difficulties contacting the practice. This includes not expecting to be offered a suitable appointment (30%), that it would be too difficult to contact the practice (17%) and being worried their request would not be taken seriously (14%). A substantial number opted for self-care – 27% decided to look after the condition themselves or wait for it to go away. The various factors that shape care-seeking decisions may mean surveys will generally find at least some instances of people delaying or avoiding seeking help in primary care (see Box 2). However, given the high number who reported delaying or avoiding seeking help in primary care and the main reasons given for doing so, our survey suggests policymakers should be concerned about unmet need related to perceived access difficulties. 

In our previous survey carried out in May 2025, it was evident that the  public viewed factors outside the immediate control of GP practices as the main reasons for access issues. That survey found that the public believes the principal challenges facing practices are not having enough doctors (41%), looking after more patients because of an ageing population (29%) and a lack of funding (27%).

Support for tax rises remains the public’s preferred option (38%) to maintain the level of care in the NHS given increasing costs (Figure 8). But support has fallen consistently since November 2022, when 53% of people supported tax rises. People who plan to vote for Labour (64%), Green (55%) or Liberal Democrat (51%), as well as people aged over 55 (47%), are more likely to support tax rises. 

By contrast, more people think that spending on other services, such as education and welfare, should be reduced to maintain the level of care and services in the NHS. 22% chose this option, an increase from 13% in November 2024.

There continues to be very little support (7%) for reducing the level of NHS care and services. Almost a third of people (29%) did not want any of these options.

Our survey reflects the dilemmas facing policymakers trying to turn around a struggling health service within a tight financial settlement. Public views of the NHS remain negative overall. Although people are less pessimistic than they were before the election, more people think that the general standard of NHS care got worse over the past 12 months and will get worse over the next year.

There are tentative signs that Labour’s focus on waiting lists for routine hospital treatment as its top priority for the NHS has shaped expectations for the better. However, the relatively small number of patients who will benefit from reduced waiting times, and the slow pace of improvements in recent months, are unlikely to be enough to meaningfully shift perceptions more widely.

Improving waiting times for A&E has become more important for the public since the election. Policymakers may be tempted to attribute this to extensive media coverage of the pressures on urgent and emergency care. However, our finding that people with recent experience of these services are more likely to have negative perceptions – including of their local health services – should ring alarm bells. While the government has committed to making ambitious performance improvements, it has yet to set out a detailed blueprint for delivery. Meanwhile, the number of long delays in A&E before patients are admitted to a hospital bed reached a new record high in 2025. If the crisis in A&E services continues to escalate, improvements in elective waiting times risk being a hollow victory – the government needs to find a way of doing both.

Making it easier to book appointments in general practice remains a top priority for the public. Nearly half of people decided against or delayed contacting their practice about a relevant health concern in the past 12 months; this suggests far too many people are struggling with access – despite record numbers of appointments being delivered. Public concerns over access are also reflected in how much people value having a prompt face-to-face appointment at a convenient time, although quicker and more convenient access needs to be balanced against other important aspects of general practice, such as the benefits of continuity of care. While the government's 10-year plan focuses on improving access to general practice, recent research suggests that the service changes linked to these reforms may have unintended consequences – including fragmentation, widening inequalities and undermining continuity of care. 

A long-standing question for policymakers and the GP profession has been whether changes to the ownership model and organisation of general practice should be a route for reform. The number of GP partners is falling: between September 2015 and December 2025, the proportion of GPs who were partners fell from 68% to 45%. Various ways of organising general practice are already being used in different parts of England, such as NHS trusts taking a greater role in managing practices. An NHS-run model such as that broadly favoured by the public in previous polling could – in theory – help over the long-term with issues around GP recruitment and retention. But it would also bring major issues, such the costs of the shift, the ownership of GP premises and the loss of flexibility and autonomy. 

More fundamentally, a unilateral shift to one single organisational model would not address the major problems facing GPs and is likely to cause massive disruption. Different ways of organising general practice will make sense in different local contexts. Given the limited and mixed evidence available on alternative models, policymakers should work in tandem with the profession and its representative organisations to consider a range of options for how general practices can be organised in future. 

There is broad public support for GP services, diagnostic services and mental health support being at the core of neighbourhood health services. However, beyond that, what the public prioritises depends on their stage of life and where they live. As local neighbourhood health services develop, policymakers will need to manage expectations and ensure local leaders have the flexibility to design services that are responsive to local priorities. 

Overall, the government has gambled that it can restore confidence in the NHS more widely by putting so much of its political focus and extra investment into delivering an ambitious pledge on hospital waiting lists. But our latest polling suggests this is unlikely to pay off while problems persist in general practice and A&E, nor is there much prospect of securing public backing for a manifesto-busting tax rise to fund extra investment. While there are no easy answers, this may be the moment for government to reassess where fixing the front doors to the NHS should stand in its priorities.