Watchdog calls for review into GP access ‘worsened by pandemic’

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.

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.’

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 medication and treatment that they need to manage their condition.

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.’

But BMA GP Committee chair Dr Richard Vautrey 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.’

NHS England primary care medical director Dr Nikki Kanani said: ‘Healthwatch rightly recognises that many people’s experience of their GP practice remained positive, despite the challenges of the pandemic, because GP teams in England carried out over 200 million appointments during the last year, and remain committed to ensuring that patients receive high quality care, with face-to-face appointments available during the pandemic.   

‘The growth of online channels has provided an additional safe and convenient way for people to ask for help, which GP teams then respond to, in the most appropriate way – either by making a face-to-face appointment, by telephoning or by using an online message or video call depending on a patient’s needs and circumstances.’     

It comes as GPs have urged patients not to block telephone lines by calling with queries about Covid vaccinations, as a CCG said one practice had 126,000 phone calls made to it in a single day.