ObjectivesPatients’ trust in general practitioners (GPs) is fundamental to effective clinical encounters. Associations between patients’ trust and their perceptions of communication within the consultation have been identified, but the influence of patients’ demographic characteristics on these associations is unknown. We aimed to investigate the relative contribution of the patient's age, gender and ethnicity in any association between patients’ ratings of interpersonal aspects of the consultation and their confidence and trust in the doctor.DesignSecondary analysis of English national GP patient survey data (2009).SettingPrimary Care, England, UK.ParticipantsData from year 3 of the GP patient survey: 5 660 217 questionnaires sent to patients aged 18 and over, registered with a GP in England for at least 6 months; overall response rate was 42% after adjustment for sampling design.Outcome measuresWe used binary logistic regression analysis to investigate patients’ reported confidence and trust in the GP, analysing ratings of 7 interpersonal aspects of the consultation, controlling for patients’ sociodemographic characteristics. Further modelling examined moderating effects of age, gender and ethnicity on the relative importance of these 7 predictors.ResultsAmong 1.5 million respondents (adjusted response rate 42%), the sense of ‘being taken seriously’ had the strongest association with confidence and trust. The relative importance of the 7 interpersonal aspects of care was similar for men and women. Non-white patients accorded higher priority to being given enough time than did white patients. Involvement in decisions regarding their care was more strongly associated with reports of confidence and trust for older patients than for younger patients.ConclusionsAssociations between patients’ ratings of interpersonal aspects of care and their confidence and trust in their GP are influenced by patients’ demographic characteristics. Taking account of these findings could inform patient-centred service design and delivery and potentially enhance patients’ confidence and trust in their doctor.

Aim: To gain insight into factors affecting patient and practitioner satisfaction with access to healthcare in a remote rural island community. Background: General practice based primary care is the focus of health service delivery in rural areas of the UK. Individuals from rural populations have reported inequalities in access to healthcare. User satisfaction with service performance is recognised as an important outcome of healthcare. Further investigation into factors underpinning patient and practitioner satisfaction with access to rural healthcare is required. Design of Study: Qualitative interviews with patients and primary healthcare practitioners. Setting: Isles of Scilly, Cornwall, UK. Methods: A topic guide was developed following review of the literature. In-depth, semi-structured interviews with a purposive sample of 23 participants were conducted with individuals from all inhabited islands. Detailed field notes were kept, and interview content was partially transcribed and analysed thematically. Findings: Principal themes identified were common to patient and practitioner participants. These were: concerns expressed regarding the equitable provision of services; obstacles to using health services; and the outlook of patients and professionals, including expectations, choice, patient-practitioner relationships and community cohesiveness. Emerging themes gave insight into a range of factors affecting satisfaction with access to healthcare. Conclusion: Despite numerous policy initiatives aimed at reducing inequities in health service provision, problems with access and uptake of health services persist amongst individuals from remote rural populations. If implemented, recent National Health Service proposals may address some of the challenges identified by participants. Service developments need to take account of local priorities, expectations, geography and demography to achieve favourable outcomes.