Factors influencing confidence and trust in health professionals: a cross-sectional study of English general practices

Richard Baker; Louis S Levene; Emilie Couchman; Christopher Newby; George K Freeman

doi:10.3399/BJGP.2025.0154

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Factors influencing confidence and trust in health professionals: a cross-sectional study of English general practices
Joti Rani Lohana

Published on: 13 March 2026

Published on: (13 March 2026)
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Factors influencing confidence and trust in health professionals: a cross-sectional study of English general practices
Joti Rani Lohana, Student, Liaquat University Of Medical And Health Sciences Jamshoro
We read with considerable interest the recent article evaluating determinants of patient confidence and trust in health professionals in English general practice. The study provides useful insight into how aspects of service delivery—such as consultation modality, proportion of GP appointments, and continuity of care—may relate to patients’ perceptions of trust. Nevertheless, several methodological considerations warrant further reflection.

First, the cross-sectional nature of the study restricts the ability to draw conclusions regarding causality. While the findings demonstrate associations between consultation characteristics and reported levels of trust, cross-sectional analyses cannot establish the temporal sequence between exposure and outcome. It therefore remains uncertain whether reduced face-to-face consultations or lower GP involvement lead to diminished patient trust, or whether practices with lower trust adopt alternative consultation patterns due to other operational challenges.^1,2

Second, the reliance on aggregated practice-level datasets raises concerns regarding ecological interpretation. Associations identified at the practice level may not accurately represent relationships occurring at the individual patient level. Trust in healthcare professionals is shaped by a variety of personal factors, including prior experiences, communication quality, and expectations, which cannot be fully captured through aggregated...
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We read with considerable interest the recent article evaluating determinants of patient confidence and trust in health professionals in English general practice. The study provides useful insight into how aspects of service delivery—such as consultation modality, proportion of GP appointments, and continuity of care—may relate to patients’ perceptions of trust. Nevertheless, several methodological considerations warrant further reflection.

First, the cross-sectional nature of the study restricts the ability to draw conclusions regarding causality. While the findings demonstrate associations between consultation characteristics and reported levels of trust, cross-sectional analyses cannot establish the temporal sequence between exposure and outcome. It therefore remains uncertain whether reduced face-to-face consultations or lower GP involvement lead to diminished patient trust, or whether practices with lower trust adopt alternative consultation patterns due to other operational challenges.^1,2

Second, the reliance on aggregated practice-level datasets raises concerns regarding ecological interpretation. Associations identified at the practice level may not accurately represent relationships occurring at the individual patient level. Trust in healthcare professionals is shaped by a variety of personal factors, including prior experiences, communication quality, and expectations, which cannot be fully captured through aggregated data.^3,4

Third, although adjustments were made for several practice characteristics, the possibility of residual confounding remains. Socioeconomic deprivation, ethnic diversity, and varying levels of health literacy have previously been shown to influence patient perceptions of healthcare providers and overall trust in medical professionals.⁵ Without detailed patient-level information, these factors may partially explain the associations observed.

Finally, the interpretation that reduced face-to-face consultations could undermine patient trust may overlook the potential advantages of remote care models. Virtual consultations have been shown to enhance accessibility and convenience for certain patient populations, particularly those with time constraints or mobility limitations.^6,7

Despite these limitations, the study highlights the continued importance of relational continuity and meaningful patient–clinician interactions in maintaining public confidence in primary care. Future research employing longitudinal designs and patient-level analyses may provide clearer insight into how evolving primary care delivery models influence trust in healthcare professionals.

References

1. Levin KA. Study design III: cross-sectional studies. Evid Based Dent. 2006;7(1):24-25.

2. Setia MS. Methodology series module 3: cross-sectional studies. Indian J Dermatol. 2016;61(3):261-264.

3. Robinson WS. Ecological correlations and the behavior of individuals. Am Sociol Rev. 1950;15:351-357.

4. Pearce N. The ecological fallacy strikes back. J Epidemiol Community Health. 2000;54:326-327.

5. Croker JE, Swancutt DR, Roberts MJ, Abel GA, Roland M, Campbell JL. Factors affecting patients’ trust and confidence in GPs. BMJ Open. 2013;3:e002762.

6. Greenhalgh T, Wherton J, Shaw S, Morrison C. Video consultations for COVID-19. BMJ. 2020;368:m998.

7. Shaw SE, Seuren LM, Wherton J, Wherton J, et al. Video consultations between patients and clinicians in primary care: systematic review. J Med Internet Res. 2018;20:e271.
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Competing Interests: None declared.

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