The cost of broken relationships: Why eczema patients are dissatisfied with NHS GPs and how relational public services can help


As industrial action continues to dominate the national conversation, and signs of a creaking state become ever clearer, it’s no surprise that public dissatisfaction with our public services is on the rise.

In no area is this more stark – and more worrying – than with NHS GPs.  According to the latest British Social Attitudes Survey, only 35% of people are satisfied with their GP services, the lowest level of satisfaction on record.

In our recent report, The Costs of Atopic Dermatitis, we’ve looked at the state of patient care for people with atopic dermatitis (eczema). Here, too, we found an all too familiar story of discontent for those suffering from the condition. 

From the financial costs of medications to an increased risk of developing depression, the costs of eczema to many patients are wide-ranging and detrimental to their quality of life. 

At Demos, our firmly held belief is that our public services are in need of a fundamental rewiring. At the heart of this shift is a restoration of the relationship that we have with public service providers. We call this relational public services.

Our interviews with health professionals and people with eczema confirmed that our diagnosis was correct. We found that broken relationships between patients and their GPs lead to people with eczema receiving care that is often inadequate and disappointing, and preventing them from getting the high-quality, preventative care they need. 

The conversations we had highlighted an array of issues and challenges that define these inadequate relationships.

Lack of dermatology knowledge

Despite the fact that dermatology cases make up 15-20% of a GP’s workload, there is no compulsory requirement for dermatology training in undergraduate or postgraduate medical programmes in the UK.

As a result, many patients we spoke to said they had often been quite shocked by the lack of knowledge some GPs have shown around basic treatment for eczema. We also spoke to dermatology specialists who had encountered many instances of people with eczema not being prescribed the most suitable medication due to ill-informed GPs. 

Lack of empathy

Too many patients encounter GPs who don’t appreciate the seriousness of eczema and the impact it has on many people’s mental health and quality of life. Patients told us that some of the GPs they see dismiss eczema as “just a skin thing” and generally show very little empathy. This lack of empathy can impede the ability of GPs to provide much needed emotional support to patients, and further impact patients ability to trust their GP: 

I just don’t trust going to a GP. I do it, but I don’t trust it, because almost every experience I have is them basically gaslighting me about my skin and about what I do to look after myself… you can have trauma related to speaking to GPs, which is really difficult, I find. 

Time restrictive appointments are a key part of the problem. GP appointments are only 10-15 mins long – this is often too short for a GP to gauge the impact of eczema on an individuals quality of life and mental health.

Of course, the problems we’re witnessing in the care of those with eczema is just a snapshot of what’s taking place across the public sector. Far too often our contact with service providers is defined by fragile relationships and poor outcomes. 

Our model of relational public services would help address this. More specialist training to reflect the range and complexity of chronic conditions, including eczema, will help GPs to better understand both the emotional and physical impacts of such conditions, and get treatment right the first time. Further, NHS England and Integrated Care Systems, in partnership with patient groups, should encourage people to join peer support groups where appropriate.