GP Access - Understanding Patients’ Experiences of GP Services in Liverpool Report - December 2018

Summary

GP services are vitally important to local people. For that reason they are a high priority for us:

• Almost everyone uses GP services and has something to say about them: they are the health service that people most want to talk to us about.
• GP services are the second highest category of enquiries from the public to Healthwatch Liverpool Information Service
• GP practices are under increasing strain and need to find new ways to address the current challenge.
• Healthwatch Liverpool needs up to date information from patients to inform our contributions to the discussions around how best to achieve this.

We heard from 1,008 patients, 953 of whom had a Liverpool GP:

• 371 from the North Liverpool GP Neighbourhood Area
• 303 from Central Liverpool
• 279 in South Liverpool

Key Findings

• There is a clear difference between patients’ experiences in different parts of  Liverpool. Patients in North Liverpool were less satisfied about getting through on the phone, getting a convenient appointment and staff attitude.
• There is a high level of satisfaction overall with staff attitudes. However the role of receptionists (such as performing triaging) is not well understood by patients and this can sometimes cause tension between staff and patients.
• There is lower satisfaction with getting convenient appointments, particularly for people with additional needs or responsibilities such as people who work, have children, are carers or are cared for.
• There is more dissatisfaction with getting through by phone. Most patients across the city make appointments by phone and know they have to phone early to get one of the limited appointments especially same day appointments. This causes bottlenecking of the phone lines. The poor phone access has many impacts for patients as well as reception staff.
• There is currently a low level of use across the city for booking online appointments. In time this could be a valuable alternative for patients who are able to use it, potentially decreasing pressure on the struggling phone systems.
• Because a significant proportion of patients do not have online access or prefer to deal directly with a person, improving online access alone is not enough to address the problems with phone access.
• People with communication needs face multiple barriers. This can include registering with a GP, making appointments, and only being able to have advance appointments due to the time it takes to arrange interpreters. In other cases family members are still being used as interpreters, which is not good practice and can create problems for the patient and their family members.

Recommendations

• Alternatives to phoning in for appointments need to be made more accessible and user friendly (e.g. extended open access/drop in hours, good online booking systems).
• We are aware of the current developments that will mean more patients will be able to access GP-out-of-hours services. While these extended hours will be helpful, patients may face similar challenges in booking these additional appointments if the current booking system is not improved.  
• The ability to pre-book appointments needs to be improved so people do not have to phone on the day to try and get what could be a pre-booked appointment or routine appointment.  
• The receptionists’ roles need to be better understood by patients to alleviate current tensions, therefore it is important for there to be clear communication about their role, confidentiality and what they can and cannot do.  
• Continuity of care is very important to many patients. Although we are aware it is not always possible to provide this, efforts should be made to prioritise this for those with mental health issues and chronic illnesses. 
• The Accessible Information Standard says that NHS services are required to ask disabled patients about their communication needs and to meet these needs. We feel this should be done more consistently. We would also like this to happen for people with English as a second language.
• There needs to be faster access to interpreters. The use of interpreters needs to be increased and the use of family members as interpreters should be avoided by practices. 
• Consider how patients without fluent English or who are D/deaf can be supported to navigate GP registration and appointment booking as interpretation is not available for these.
• Review the implementation of the Extended Hours Access to assess its impact and improve its accessibility.