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People's ten most common problems with primary care

We know from our conversations with the public that they are grateful to the many staff behind the services who work to ensure we all lead long and healthy lives. Official figures show 85 per cent of people are satisfied with the services they receive. Yet, as our previous research has shown, satisfaction rates only tell part of the story.

To really understand people's experiences our network has spoken to more than 11,000 people and visited over 550 GP surgeries and other primary care premises such as pharmacies and opticians across the country.

Some of these problems are already well known, others continue to persist despite measures taken by policy makers and politicians, and a few are new issues.

Download the full report or download the report summary.

"I struggle to access primary care services"

Disabled people spoke to Healthwatch about their difficulties accessing services, from physically being unable to enter buildings to inflexible on-the-day booking systems making it difficult to book carer support for appointments.


For example

Healthwatch Luton visited all 39 local GP surgeries and found that 28 did not have a hearing loop system installed for patients with hearing difficulties, and 26 did not have easy access for wheelchair users.

Healthwatch West Sussex looked at 53 practices and found that less than half had hearing loops. 

14 dental practices reviewed by Healthwatch Redcar and Cleveland four practices were unable to provide disabled access and limited access for the elderly or infirm.

 

'It can be difficult, because there is a bit of a groove where the step used to be, I can’t always get the chair in, but there is a button there for assistance.'

Respondent to Healthwatch Oxfordshire

"I'm struggling to register with a GP/dentist"

Healthwatch heard from people struggling to find an NHS dentist, as few as one in five surgeries in some areas registering new patients. There was also widespread reports of patients finding themselves being 'deregistered' without warning if they hadn't been for a check-up.


For example

Healthwatch Leicester found that just 18 of 58 dentist surgeries were accepting new NHS patients, leaving large areas without any provision for new patients.

When they raised this with the NHS England Local Area Team they were told patients would ‘just have to travel further’.

'I was told I had been sent a slip I had to complete and return to stay on the list. I never received this or any reminder of it either. I simply didn’t get invited for appointments anymore and when I rang I was told I had been “deselected”.'

Respondent to Healthwatch Bradford

"I can't get a GP appointment so go to A&E instead"

A consistent theme across all the reports was the frustration patients experience booking appointments. This is having a knock on effect on the rest of the system. Our report identified that one in five patients faced with long waiting times to see their GP are going to A&E instead.


For example

The most common issue was with poor telephone systems. Nearly half (47 per cent) of those who responded to a survey by Healthwatch Liverpool said that booking over the phone wasn’t easy, with one resident in Halton reporting having to wait 47 minutes for someone to answer the phone.

The Government has set a target for all surgeries to offer online booking by March 2015, but a search by Healthwatch Enfield showed that two out of five local surgeries still don’t have their own website.

“When you phone first thing in the morning (8.30am) you are put in a holding queue.  After 5 mins if you haven't been answered (which is always the case) you are automatically disconnected.  This process can occur 2 or 3 times in a row. When you finally get through about 20 mins after surgery opens there are no appointments left!”

Respondent to Healthwatch Warwickshire

 

 

"I struggle to communicate with my doctor because of poor translation services"

Changes to the way translation services are funded has left many deaf people and those who speak English as a second language struggling to communicate with their doctor.


For example

Healthwatch Islington raised serious concerns about the lack of support for women from minority ethnic communities. For example, they explained that victims of domestic violence have been unable to disclose their situation because the assumption that their families would provide help in translating for them has left them relying on their husbands as the only source of support.

Beyond GP services, Healthwatch Kirklees interviewed 410 people with hearing impairments and found that two out of three experience difficulties communicating with opticians and dentists.

 

 "The appointment was terrible. I was embarrassed with my friend in the room. They just weren't deaf aware."

Respondent to Healthwatch Kirklees

"I can't see my preferred GP"

The NHS constitution gives people the right to see the GP of their choice, and calls on practices to comply where possible. Yet reports suggest patients' preferences are often not met.


For example

Healthwatch Surrey found that a third of patients from across the county were either ‘rarely’ or ‘never’ able to see their own family doctor.

Healthwatch Liverpool found that a fifth of patients are not even being given the opportunity to specify the gender of GP they want to see, resulting in people not seeking medical attention for sensitive issues.

'There weren't any appointments and I didn't want to see another doctor or else I would have to say everything all over again. I tried to explain this but they wouldn't listen to me so I ended up with a gap in my anti-depressants.'

Respondent to Healthwatch Warwickshire

"I don't know which healthcare service to use when"

Patients don’t always feel they have enough information to know which healthcare service to visit. In particular, our national poll revealed that more work needs to be done to promote out-of-hours services, community pharmacists and walk-in centres to improve consumer experience and reduce pressure on other parts of the system such as A&E.


For example

Half of the people Healthwatch Enfield spoke to didn’t know about the out-of-hours options open to them.

Similarly, in a spot check of surgery answerphone services, Healthwatch Hampshire found that more than a quarter of the 144 surgeries across the county were still giving out the wrong out-of-hours number over a year after the introduction of the NHS 111 service.

‘I had no idea that pharmacies provide services such as blood testing service, vascular risk assessment, sugar testing, BMI so they must advertise more. It would be fantastic if all pharmacies offered these services.'

Respondent to Healthwatch Waltham Forest

"I feel rushed in my appointment and need more time"

Healthwatch heard from patients who are unhappy with GPs applying fixed length appointments. Patients reported feeling rushed and struggling to make themselves heard, particularly if they have multiple health problems.


For example


Healthwatch Halton found that six out of ten local residents weren’t happy with the length of appointment available and that doctors were often unwilling to listen to more than one symptom.

Healthwatch Oxfordshire spoke with a number of patients with visual impairments who raised concerns about not being granted extra-long appointments to help them go through such details as how to take their medication and what side-effects to expect.

 

"GPs should listen well, if one has 2 or 3 problems at the same time GP says for every single problem I have to book another appointment”

Respondent to Healthwatch Waltham Forest

"I don't know how to complain about my care"

We know from our “Suffering in Silence” report that the complaints system is utterly bewildering for people to navigate. This is made even harder by a lack of information offered by healthcare providers.


For example

Healthwatch Newcastle conducted a mystery shopping exercise across 42 practices and found that only half had leaflets at reception explaining how to complain.

Even where information is available, patients have to raise their concerns with the practice manager and are often left with no choice but to go back to the same GP in the future. It is not surprising then, that one in four of those we have spoken to said they were worried about the impact complaining would have on their care.

One resident in London told Healthwatch Lambeth that they daren’t complain in case they were ‘accidentally’ given the wrong drugs.

'We requested to see the Practice Manager, and were told that complaints should be routed through GP. After submitting written complaint to GP, we had no written communication back from GP or PM.'

Respondent to Healthwatch West Sussex

"I don't think staff are as compassionate as they should be"

The attitude of staff, particularly GP receptionists, often came up with patients reporting that they found them to be nosy, abrupt and often rude.


For example

Healthwatch Bradford collected feedback from nearly 600 members of the public about local surgeries, many of whom complained about poor attitudes of staff.

Similarly, focus groups held by Healthwatch Richmond recorded reports from patients of receptionists “screening calls via invasive questions”, reporting that they found them to be nosy, abrupt and often rude.

'I once felt I had spiders crawling all over me. I knew it was all in my head but try explaining that to some bossy woman at the desk who hasn't the first clue what people with mental health issues have to go through without half the patients looking round at you.'

Respondent to Healthwatch Bradford

'I need more information to make the right choices about my care'

Healthwatch identified a need for better information for people to ensure they can make informed decisions about care. In particular, better signposting and wider use of plain English is needed to help ensure patients are accessing care at the right time and that they have the ability to self-care when appropriate.


For example

Healthwatch Barking and Dagenham found that children were attending the dentist too late to prevent tooth decay. Even though the parents in question knew the service was free, many were working on the assumption they should only take their children to see the dentist if they were in pain.

It is this sort of misunderstanding that contributed to the 26,000 five to nine years olds requiring emergency surgery in 2013/14.

'Sometimes they write something down for me – but my English isn’t good and it’s unclear to me what they mean. They know I’m Deaf – but I don’t think they understand that I don’t read English the same as hearing people.'

Respondent to Healthwatch Kirklees