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28.09.2016

GP services are becoming less personal say Croydon residents

Residents are seeing Croydon’s GP services as less personal, according to a report by Healthwatch Croydon. Issues include difficulties in booking appointments by telephone, clinical judgements made by receptionists, and weeks of waiting for routine appointments with a preferred doctor. Many residents do not get to see a GP of choice, or a GP at all, with many not knowing who their GP is.

Croydon has 57 GP practices, with 403,045 registered patients according to NHS England. Healthwatch Croydon, the local champion for better health and social care, heard the views of over of 1,856 patients across Croydon from 1 September 2015 to 31 August 2016 with every practice represented. This report is reflective of their views, experiences and expectations of a service that nearly every resident uses.

This report is timely as the NHS Croydon Clinical Commissioning Group (CCG) will shortly be developing plans on how Croydon GP services will be delivered in the future, as part of the national NHS Five Year Forward View, find out more here.

The report says that patients are broadly satisfied with the quality of treatment received, with many accounts of professional and knowledgeable doctors and nurses and positive about receptionists and practice management, on the whole.  Most patients are well aware of the pressures, particularly on demand, and understand the waiting times and limited options.

However, there were some issues of concern:

Non-emergency accessibility: Emergency appointments are made within a reasonable amount of time, but booking non-emergency appointments can be difficult particularly by phone. As there is a lack of appointments, the process is repeated on following days. Online booking, although widely promoted, offers limited choice.

Receptionists making clinical decisions: While deciding the priorities for treatment (triage) is necessary, some patients express concern that receptionists may be making clinical decisions.  GP telephone triage is considered a poorer quality consultation.

Delays and comfortability: Some practices can consistently run late on their appointments and some waiting rooms are not as well maintained as they could be.

Clinical Treatment: Most patients say that consultations are generally of good quality, but some feel they are not actively involved in decision making. Patients comment that GPs can be too quick to prescribe with a lack of alternative options.

Administration: Issues includebeing unable to register and then not advised on alternative options, even in situations of need and receptionists taking an enhanced role in repeat prescriptions and communicating test results with the risk of error. One patient found an incorrectly doubled dose and some received an incorrect diagnosis.

The report makes the following recommendations:

Capacity: Staffing and phone capacity should be able to accommodate as many callers as possible during peak times. Online alternatives need to be more effective.

Assurance: When triaging, staff competency needs to be demonstrated. Safe working practices should be clearly demonstrated, with staff fully trained, and adequate safeguards in place to ensure that mistakes will be unlikely including a second opinion.

Service: Patients should be informed of delays, not simply left in their chairs and a pleasant environment will make patients more relaxed, and less anxious.

Being listened to: It is important that patients feel listened to, are respected, and involved in any decisions. Despite time constraints, GPs should do their best to get to know their patients and listen, before making decisions.

Informed: Patients should be equipped with all available information for referral and any other information and signposting advice.

Healthwatch Croydon’s Annual Meeting on Wednesday 5 October will focus further on this issue, with a workshop which residents are encouraged to contribute and open the conversation further. Guest speaker, Paul Young, CCG Deputy Director for Commissioning will be there to hear views and answer questions.

Charlie Ladyman, CEO of Healthwatch Croydon said: “It is good that Croydon residents broadly believe GP services are of high quality, and that there is an appreciation that services are under pressure. However issues of capacity, assurance and listening to patients need to be addressed. These issues are core to the success of any health service and with GPs being the most used service, it is all the more important.

“This report is timely, as it has started the important conversation that we need about GP services. Decisions will be made by the CCG in the next years in line with the national NHS Five Year Forward Review. We look forward to working together with all the key decision-makers providing insights into how patients see services to bring improvements.

Dr Agnelo Fernandes, local GP and Assistant Clinical Chair of Croydon CCG, said: “We welcome this report, which shows that patients are aware of the pressures that GP practices face in meeting the needs of Croydon’s population. It is clear, however, that patients’ experience of GP services is variable, and we look forward to working with Healthwatch to understand these issues more closely. We are collaborating with our practices and with NHS England to further develop and improve GP services in line with patients’ feedback and with the NHS Five Year Forward View.

A spokesperson for NHS England (London) said: “While we are pleased that Croydon residents are broadly satisfied with the quality of treatment and services that they receive from their GP, we know that there are areas where patient experience and access to services can be improved. We will continue to work with our partners to make this happen, in line with the ongoing work of the General Practice Forward View. In particular we hope that advances in technology will translate quickly into a more responsive service for patients.”

You can view the report here. 

Other surveys not related to Healthwatch Croydon’s research are also available including the national GP Patient survey which can be viewed at https://gp-patient.co.uk/surveys-and-reports

Read coverage on this in the Croydon Advertiser.

Read coverage in this in the Croydon Guardian.