Last month after being nominated by some of our patients, we won the RCGP/Leonard Cheshire Disability Care Award. The premises is now at least twenty years old, so delivering the highest standards of access we aspire to has proved a challenge.
This challenge has proved strength in making us more critically aware of our premises and made us more flexible and creative in making adaptations. There's often a lack of feedback from patients about adaptations for disabled patients, so being awarded for our work by the RCGP was encouraging.
While the changes haven't attracted a lot of new patients, we would recommend what we did to other practices. For practices in England, the CQC will assess accessibility, and all practices in the UK must also comply with the Disability Discrimination Act (DDA) 2010.
It is difficult to estimate costs as the changes were made incrementally over four to five years. One tip we would make was to get involved in pilots, so that your practice can receive equipment and training in that equipment for free.
What we did
We began to seriously make changes in 2007. Our premises are not particularly old but access for some was still an issue. We used the RCGP EQuIP Cymru toolkit to help us identify where we could make improvements and to developed a Disability Equality Action Plan. The guiding principles in the toolkit are:
- Someone in authority at the practice needs to be willing to lead on developing and maintaining your plan
- Agree on what are the most important messages
- Try to think of the five things you could do which would make the most impact on disability equality for your practice.
- Agree within the practice on what the next steps must be, who will do them and by which date.
- Decide which resources you need to carry this forward.
- Decide when you will review progress: make sure that Disability Equality is reviewed at least yearly within the practice.
Following this plan, we decided to take the following steps:
1. We sought local support
We invited local disability groups to the practice to be involved in effective staff training sessions promote staff awareness of services available. In particular the practice has strong links with the local carers centre and a local self help foundation, where all medical students attached to the practice spend time during their placement. We believe that this input has enabled our staff to have a high level of awareness of the needs of patients with a disability.
2. We trained our staff
All our staff received a programme of disability equality training during successive protected learning sessions focussing on individual areas at each session - sight, hearing, physical, mental health, learning disability, gender, and social equality. These are also covered at induction with new staff via a disability qualities briefing session supported by summary briefing notes for reference. We also try to regularly evaluate the effectiveness of our training and changes, again using the EquIP Cymru audit tool.
We have been very fortunate to have the support and input of patients with a disability who have been willing to give their time to enable staff to practice using new equipment such as potable induction loops and sign translation software and to gain proficiency in using these in a supported environment.
3. We improved communications and technology
We started to make longer appointment slots available as necessary for some patients, and we developed a kind of flagging system which alerts receptionists to the possible need for longer appointments for some patients.
Four members of frontline staff undertook basic training in British Sign Language and people with hearing impairment or deafness are able to sign up to send and receive SMS communications (mobile phone text messages) to request appointments, home visits or repeat prescriptions. The practice also offers Minicom; induction loops, (fixed and portable) sign language interpretation via video-link to sign translators trained in medical terminology.
We also now have self check-in machines at wheelchair height with a high contrast option for patients with visual impairment; fax and SMS; prescription requests for deaf and deafened patients to supplement online access to these services, reading /writing aids and writing tables at wheelchair height.
Visual display call systems have been fitted in our surgery waiting areas: hydraulic couches are available in all rooms and treatment areas; further flagging of individual patients records to alert staff to any individual special needs (need for sighted guide, deafness or hearing impairment etc.); large scale high visibility numbering/signage to consultation rooms was put in place and sight-line markings to any steps and at changes to floor level. Standard patient correspondence uses plain language and a large, clear font (Arial and Verdana are good). Practice leaflets are available in large print, Braille, and audio-guide format.
We have also benefited from being involved in a pilot project on improving accessibility of services to the deaf community through use of Sign Translate®software which enables IT-based translation of everyday phrases/terminology for use in both reception and consultation in a variety of languages – not just BSL with real-time access to trained sign translators via video link.
Community services for the elderly with mental health problems are also held weekly on-site to enable patients and their carers to be seen by a multi-disciplinary team in a local and familiar setting.
4. We assessed carers' needs
We actively screens patients for carer status at each new patient registration, also opportunistically during consultations and by poster campaign, to encourage carers to register their status, and if wished, to direct carers to social services/voluntary agencies for assessment and support. A dedicated notice board in the surgery alerts carers to items of news regards benefits, new services etc and we also publish a directory of local voluntary and support agencies for specific disabilities for carers.
Dr Ann Burtonwood is the practice manager and a partner at Porthcawl Practice.
