General Practice Access Short Life Working Group: access principles

5. People Engagement

The Healthcare Improvement Scotland (HIS) - Community Engagement team gathered feedback from the public through face-to-face interviews and group discussions. The team also emailed a short electronic survey to all members of the Citizens’ Panel. This work was conducted in March 2023. A link to the full report is in Appendix 3.

5.1 Face to Face and Group feedback

Healthcare Improvement Scotland - Community Engagement offices gathered views using a mix of face-to-face interviews and group discussions. In total, thirty people shared their feedback. The team recruited people from community groups including Patient Participation Groups in Tayside and Ayrshire, Coll Collaborative Group, NHS Western Isles Patient Panel, South Lanarkshire Health & Social Care Forum and Chance to Change Group (Glasgow).

When the team asked participants what mattered to them about accessing a general practice, they said it was important to be able to contact “the right person” and being able to speak to someone or access services when they needed to. They stressed the importance of getting “timely support” whether that be from the GP or another member of the MDT. There were issues raised about timely access via telephone, appointment availability and concerns about confidentiality.

Participants discussed what good access would look like and compared this to where it would, in their opinion, fall short.

Participants considered the Scottish Government’s draft principles and overall, they felt that they were positive and much needed. There was some feedback about accessibility and the language used and this is documented in the full report Appendix 3. The participants considered each of the principles in turn and the feedback captured.

Participants felt the principles were “good, clear, concise and easily understood,” providing some of the terms and wording was changed to add clarity. Some participants though felt the principles were “too clinical and operational” and questioned whether they would be meaningful to all people. They also felt that there needed to be monitoring of the implementation of the principles and there should not be a reliance on patient complaints to assess whether they were working or not. Participants expressed the need for choices for accessing services should be more available for everyone and recognition that not everyone had or could access a telephone or IT (digital) facilities.

Some participants said that it was “quite disheartening” to know that ways of working were not as described by the principles already. They felt the principles needed to be in Easy Read and Plain English and others wondered whether the principles were aimed at professionals or the public because of the way the principles were currently worded and not easily understood by people.

Within the discussion participants considered what a practice meeting all the principles would look like and said that it would be one which was:

“accessible, equitable, flexible, inclusive, responsive, approachable, welcoming and non-judgemental.”

People needed information about “who does what” within the practice – one participant said that a lot of people do not understand who the different staff were nor how to access them.

Whilst the discussions centred on gathering views on the draft principles, it was clear that there was an appetite to discuss how people can access general practice services, more generally, and a real willingness to share their experiences.

5.2 Feedback from Citizens’ Panel

Following the face to face and group work described above, the team emailed a survey to all 938 existing panel members for whom HIS hold email addresses. The team received a total of 449 responses (48% response rate) by email. This level of return provides data which is statistically robust at national population level and representative of sex, age, deprivation, and housing tenure.

The survey opened by asking respondents what they believe matters most when accessing their general practice. Most important to panel members was:

1. being able to access appropriate care in a reasonable time (45%),

2. followed by a reliable appointment system (31%)

3. and appointments with appropriate healthcare practitioners (26%).

The team asked respondents for their opinions on the main principles to accessing their General Practice and whether they agree or disagree with them. Almost all respondents agreed or agreed strongly with each of the principles with respondents being most likely to strongly agree that access to General Practice for people should be easy, clear and fair and at a time in keeping with need (89%). Slightly fewer respondents strongly agreed that General Practices should help people to be seen by the best and most appropriate person (85%) or that people should have a reasonable choice about how they access services, and that services should be approachable, sensitive, and considerate to needs (77%).

The team showed panel members a list of principles and statements and asked which were most important to them. The three principles which panel members identified as being most important were:

1. When appointment availability is limited, General Practices should ensure that those with the most urgent care needs are met (72%).

2. People and General Practices should have a positive and trusting relationship (66%).

3. People who live with frailty and health needs must have a known and trusted member of the General Practice team aligned with their care (60%).

Most panel members (59%) agreed fully that the principles were clear and understandable and a further 38% agreed somewhat. Only 3% felt that the principles were not clear and understandable and 1% were unsure.

The team asked those panel members who said the principles were not clear or understandable how the principles could be improved. Around a third of comments were where respondents felt the principles should be clearer (33%), and a further 21% felt they should be understandable to everyone. Other suggestions were for the team to provide examples setting out what the statements mean (18%) and where they questioned what the statements mean in practice (17%).

The team asked all panel members if there was anything else they would like to see included in the principles or statements. Over half of respondents who answered said there was nothing else they would like to see included (54%). The most common suggestions were regarding lengthy waits for appointments or on the telephone (10%), accessing appropriate care (9%) and regarding the role of receptionists as gatekeepers (6%).

Finally, the team asked panel members how they think General Practices should raise awareness of when people should use the services of the MDT rather than the GP. The most common response was that information should be provided on the General Practice website (54%) and this was followed by information made available at the General Practice, for example via leaflets or posters (50%) or directly from the receptionist (44%).

Recommendations

Based on the feedback above, it is recommend that:

• General practices across Scotland are encouraged by Scottish Government and professional leaders to increase the involvement of people in changes to services.
• General practices look towards the development of new ways, systems and processes for capturing people’s experience particularly in the design of services and change ideas.
• As a matter of course, General Practices use the Access Principles when engaging with their practice population.
• Scottish Government and HIS – Community Engagement considers whether a further Gathering Views exercise on access to General Practice services would be beneficial in the longer term.