Notes from the field of public involvement

Monday, 03 October 2005

What people say about primary care if you listen to them

Health Secretary Patricia Hewitt is right to say she is listening to people. But will she hear what they actually say? The first two of five regional events in the “Your health, your care, your say” campaign staged by Opinion Leader Research (price tag £1M according to documents obtained under Freedom of Information) are over. The people around Gateshead and Leicester (or at least a hand-picked 149 of them) have had their say.

Access, access, access

It’s no surprise that difficulty in getting access to their GP and appointments at convenient times for their work and personal lives is strongly exercising many patients. Access to primary care professionals they know and who have their records on tap was the top issue at the Gateshead meeting. “Ensuring access to services where, when and from whom people want them (especially out-of-hours appointments with GPs)” was something the Department of Health should do right now.

Leicester produced the same message: “access to GPs (appointments, availability, ease of access)” was top of the list of things that weren’t working well and they wanted it improved – now.

How one local practice achieves improved access

Balham Park Surgery is an award-winning inner London practice with some 12,000 patients. Since 2001, it has run an extended hours service, now funded by Wandsworth PCT as an “enhanced service”. This provides booked GP and nurse appointments for patients before (from 7 am) and after (until 9 pm) normal surgery hours on two days a week and on Saturday mornings. These appointments are virtually 100% utilised and demand is at a consistently high level. This compares with a “did not attend” rate for “in hours” appointments of some 8% in this practice. This is not an overspill of people who cannot access doctors or nurses at usual times. It is people who choose appointments at these extended times because they fit in with life and work needs.

In the last financial year an additional 2,054 patients (17% of the total practice population) were able to see a GP at Balham Park Surgery because this scheme exists. In addition some 2,926 patients saw a nurse during extended hours last year. The extended hours service takes account of rapidly changing local demographics. Some 48% of scheme users (990 patients) during the past 12 months who saw a GP came from the fastest growing part of the local population – working people aged 25-34 – who cannot take time off at other times. One-third of these (301 patients) were younger men – a group notorious for under-accessing primary care. In addition, 139 children under age 16 used these appointments, generally because they were brought by a parent before or after work. All of these adults and children would have little or no alternative GP access because the “in hours” appointments have no spare capacity.

Having bookable extended hours appointments undoubtedly relieves some of the pressures that would otherwise fall on the local A&E service, now seeing some 300 people a day, and the local Walk In Centre which is already running at 300% over capacity.

Inefficient primary care has to go

PCTs don’t like to admit it, but primary care isn’t good in many pockets around the country. It’s not acceptable for the NHS to sidestep the issue by creating alternative primary care centre-type services. That’s not what people want most, as Ms Hewitt’s consultation meetings are starting to demonstrate. What people do want is a good, flexible and comprehensive service from the primary care practice they belong to already. The Balham Park Surgery experience in South West London validates what the people of Gateshead and Leicester said. It also confirms the BMA’s national MORI survey in April 2005 which found that people value being able to see GPs and nurses at local surgeries. Patients want a high quality experience where they can see staff they know at times convenient for them and who have their records immediately available to ensure continuity of care.

Limited appointments on weekdays only just won’t do. If some practices can’t or won’t provide this, then they should be shut down or franchised to operators who can provide what patients want. Of course, that could – and probably will – mean Foundation Trust hospitals surging into the primary care market in early 2006. But would that really matter in terms of patients getting improved access to primary care?

It’s about customer satisfaction

John Hutton made a point in his recent speech on public service reform at the Social Market Foundation that we strongly support: “It is by embracing customer satisfaction as the key driver for public services – finding out what people actually want from their services and using that information to drive change programmes - that we can help public services catch up with the best on offer in wider society.” Ms Hewitt herself told an NHS Chairs briefing only a few days ago that “we will use our consultation exercise - Your Health, Your Care, Your Say - to generate and gather the innovative ideas from across the country about what services people want and how they want them provided.”

There is plenty of evidence piling up that convenient access to local, high quality, flexible primary care is what will keep the NHS’s customers most satisfied. Will the Department of Health be bold enough to see that they get it as we all hurtle towards the goal of a “patient-led NHS”?

Roll on London, Plymouth and Birmingham meetings …. and the White Paper in December to see the story unfold.

Andrew Craig | Send feedback