Summary of report content
Healthwatch Bexley undertook a survey about access to GPs during August 2021. 685 people responded.
They found that public perception was of GP practices running a reduced service, were closed, had restricted access and were not seeing patients face to face, with little or no patient choice being offered. Many reported seeing little or no change to access since Government restrictions started to lift in July 2021 despite other services such as dentists and hospitals being more open and the government announcing ‘business as usual’.
People felt practices still had barriers to access and didn’t understand why questioning what staff were doing if not seeing patients or answering the phones. If they did manage to visit the practice, waiting rooms were empty and very few staff visibly working, compounding the perception that the practice was not busy.
Pre-pandemic people could not get through to their practice by telephone and for many this has worsened during the pandemic, with patients becoming frustrated with long waits on hold, being cut off or being told once the phone was answered that they needed to complete an online consultation (or that no appointments were available).
Primary care has reported receiving significantly higher call volumes than pre-pandemic, which they could not always cope with. One local practice had 1,000 calls in a day and another 600 calls, volumes that are physically impossible to deal with.
The move to a total triage system and digitalisation has worked well for some who have found it more convenient to use online consultation or have a telephone appointment, not needing to take time off work or travel to appointments. Others felt the triage system meant they had experienced shorter waiting times for appointments, both phone and face to face, than pre-pandemic as patients were prioritised according to need.
People questioned the confidentiality of the total triage system, and the need to discuss personal medical problems with reception staff who are seen as the gate keepers to appointments. Sometimes describing reception staff as uncaring and un-sympathetic showing little understanding of the frustration people have experienced in the often lengthy process of contacting the practice. Patients’ tempers sometimes fray if they feel reception staff are rude or short with them. Conversely, there is little understanding from patients about the pressure reception staff are under from callers who are not happy that they have waited for their call to be answered and find no appointments available or a long wait for an appointment.
Training and support are vital for public-facing staff who need to be caring understanding and show empathy for people frustrated at trying to access their practice. The public also needs to be made aware of the pressure reception staff are under and that it is unacceptable to be rude or abusive to staff who simply may not have an available appointment.
The move to digitalisation was needed to help keep both patients and practice staff safe from Covid. It is now an integral part of primary care which is likely to stay. Although it works well for some, online consultation was found to be frustrating, often sending them in circles, asking them to call the practice or contacting other services such as NHS 111. The online consultation system needs to be improved to be more efficient and user friendly. People said there was a ‘knack’ to completing the form which may include dumbing down their answers, so they weren’t redirected to A&E.
A vast difference in what happens after an online consultation was completed was found. Some received a fast response, whilst others heard nothing at all or for days and were unsure how long they should be expected to wait before they were contacted. This created concern over whether the form had been seen and what they should do. Concerns were raised about confidentiality and who looked at the online consultation forms. People should be informed and given guidelines about what to expect once an online consultation has been completed, including who looks at the form, timelines and information about when and how they may be contacted and by whom. This would help build people’s confidence in the system and may encourage wider use, freeing up the phone lines for those without digital access.
Face to face appointments are often people’s preferred choice of engaging with primary care and should be offered when appropriate but the introduction of phone appointments is a positive step for some patients. Others may need more reassurance and understanding that phone appointments are effective in diagnosing certain conditions or as a way of assessing needs, to build patient confidence. If a patient feels they can communicate better face to face or that they need to show the problem to medical staff their right to choose should be respected. Patients must be made aware of the practice procedure for phone appointments, such as a time frame for the call so that patients are not waiting indefinitely for practice calls and know what will happen if they miss a call.
The patient’s situation also needs to be taken into account. People had missed calls as they were not given a time frame or choice of when the call would happen and were working or were unable to talk privately at the time of their call.
The report contains 7 recommendations to improve access to GPs.