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Watchdog calls on NHS England to review access to GP care

by James Hacker
22 March 2021

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NHS England should undertake a formal review of how patients access GP services to help practices address potential barriers to care exacerbated during the pandemic, Healthwatch England has said.

The recommendation was made in its report published today (22 March) on how patients accessed primary care services before and during the Covid-19 pandemic.

It found that the switch from face-to-face to remote consultations had not ‘met everyone’s needs’ and that patients had increasingly struggled to get through to GP surgeries.

The BMA said it was ‘acutely aware’ that remote consultations did not work for everyone but warned that ‘a chronic lack of resources’ was behind many of the issues highlighted in the report.

Switch to remote consults

Healthwatch England, the independent champion for users of health and social care services, analysed the experiences of almost 200,000 people shared between April 2019 and December 2020.

Of 1,190 who were polled and had booked an appointment since March 2020, 75% had booked via telephone, with 18% and 5% by internet and in person, it found.

The report said that while telephone appointments are convenient for many patients, concerns over missed diagnoses were ‘exacerbated for disabled people, people with long-term health conditions, people without access to the internet and for anyone whose first language is not English’.

It added: ‘This shift has happened extremely quickly, and there is little evidence that people have been consulted about how they view these changes. Therefore, there is a need for NHSE to incorporate patient experience within an access review.’

‘Continuously engaged’ phone lines

Healthwatch also found an increase in reports of problems contacting GP surgeries via phone since September 2020. It said that patients reported waiting in long queues, having to call back throughout the day, or finding the line ‘continuously engaged’.

One local Healthwatch, Healthwatch Medway, found that ‘26% of GP websites had no information about the new procedures in place’, which it said left patients ‘worried about accessing care safely’.

Healthwatch also reported that the online and telephone triage systems used by practices to determine which type of appointment would be most appropriate, can mean ‘people might have three interactions with their GP surgery to get the care that they need’.

The report also found that people had struggled to get appointments for regular health check-ups, treatments and medication reviews, which had left some unable to get the care they need to manage their condition.

NHS England should support GP efforts

A formal review of the ways people access GP services would ‘help establish the changes that are working well’, Healthwatch said, and would identify areas where practices need additional support to address barriers.

The report added that an NHS England review should look to ensure GP practices are able to better record and identify people with additional needs, such as by using carer identifiers or language support needs.

It also called on NHS England to support GP practices to consider how different patients may have different communication needs, and to help them to adapt accordingly.

Staff using telephones to communicate with patients should also be supported with call handling training, it said.

‘This will ensure that staff are well equipped to deal with concerns over the phone and are familiar with the software, equipment and supporting the patient.’

BMA response

Responding to the report, Dr Richard Vautrey, GPC chair at the BMA, said general practice had worked ‘incredibly hard’ to provide patients the care they need and practice teams have also ‘felt frustrated’.

‘We’re acutely aware that remote appointments don’t work for everyone, as this report highlights, but it’s important to dispel the myth that patients without access to the internet have in some way been abandoned and simply cannot access their GP,’ he said.

‘The vast majority of initial contacts are through telephone consultations, and indeed the speed and convenience of access to services has improved for many as a result.’

Dr Vautrey also said that the ‘constant changing of operation – down to a lack of preparedness from Government’ had placed significant pressure on practices and impacted booking systems.

‘At the outset of the pandemic we had insufficient GPs and practice nurses, and that situation has not yet changed, so putting greater pressure on the remaining workforce. There is an urgent need to recruit and retain more staff in general practice to help improve access,’ he said.

He added: ‘We understand that the pandemic has been difficult for many of our patients – it has for us too – but it’s important to remember the context practices are currently operating in; a once-in-a-generation health crisis with minimal Government support. Government and NHS leadership must learn from this, to ensure services are better prepared for the future, and that GPs are never left again without the resources and funding they need.’


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