A topic that came up in conversation recently with a practice manager surrounded how GP practices can be responsive to the needs of its population. This is something that practices definitely need to keep an eye on, especially as it’s an area that CQC inspections focus on and given the population of the UK is becoming increasingly diverse.

Understanding equality and diversity is vital if we want to deliver person-centred, safe and effective care. After all, as the CQC itself states, the generalist approach to care is a key strength of UK general practice. It therefore follows that GP practices should be proactive in understanding the needs of different groups of people and deliver care to meet these needs.

Contractual obligations

It’s worth remembering that anyone, regardless of nationality and residential status, may register and consult with a GP without charge. The NHS Constitution sets out:

• The right for members of the public to choose their GP practice, unless there are reasonable grounds for the practice to refuse, and
• The right to express a preference for using a particular doctor within their practice and for the practice to try and comply.

Helpfully, the General Practitioners Committee of the British Medical Association has published guidance on patient registration to clarify what is required of practices within England to meet their contractual obligations.

What inspectors want to see…

When CQC inspectors call, one of the key areas they will investigate is whether the practice is playing an active role in improving population health – across the entire practice population.

Nigel Sparrow, Senior National GP Advisor and Responsible Officer, says in his popular Mythbusters series of articles that the BMA’s guidance informs the CQC’s judgment on how responsive a practice is and whether it is organised to meet people’s needs.

Nigel explains: “We expect practices to meet their duties around providing emergency and immediately necessary treatment. When a patient does not require emergency or immediately necessary treatment, practices only have limited discretion about whether to register the person.

“Our key line of enquiry (R2) looks at how well services take into account of the needs of different people, including those in vulnerable circumstances, which can include gypsies, travellers, vulnerable migrants and sex workers.”

Further information on a couple of ‘at risk’ groups can be found here:

Nigel’s surgery 29: Looking after Homeless Patients in General Practice sets out our specific expectations for meeting the needs of homeless people.

Nigel’s surgery 36: Registration and Treatment of Asylum Seekers abd Refugees sets out our expectations for meeting the needs of asylum seekers and refugees

Nigel adds: “GP practices provide care to their local population and this includes the most vulnerable in our society. Practices are in a key position to tackle health inequalities and so it is essential that vulnerable and social excluded groups of people can access good quality health care. This starts with being able to register with a GP.”

Delivering effective patient care

With the above in mind, how can practices ensure they’re delivering effective care across a diverse population?

Good practice dictates that surgeries must be able to:

• Identify and respond to the specific needs of diverse patients, service users and carers which arise from their personal, social or cultural background;
• Be accountable for providing a service which demonstrates good equality and diversity practice; and
• Support the empowerment of patients, service users and their carers so that they may be involved in their own care and health improvement.

Good equality and diversity practice involves:

• Communicating with patients, service users and carers in a way that is accessible to them;
• Making reasonable adjustments in the way we do our work and deliver our services to take account of the particular needs of disabled people;
• Understanding the role that cultural and religious beliefs play in health care and peoples’ experiences of the health service;
• Ensuring that everyone gets care which takes account of their individual needs;
• Treating everyone with dignity and respect at all times.

Training and development

A good way to find out if your practice meets the above criteria is to run a short exercise.

Consider the population within your local area, the information for which should be readily available from your CCG, local equality and diversity representative or local authority. Armed with that information, you can then run through the following:

1. Select a client group that either uses your service or potential service users that you want to make your service more accessible to.
2. Hold a discussion with colleagues and/or service users from this client group to establish what kind of information they might need and if it is available in an accessible format.
3. Consider the barriers this client group might have to your service and to information, such as language or sight difficulties, travel issues and so on.
4. Consider how you might address any gaps to improve your service for this client group, such as special treatment or the use of interpreters.
5. Repeat for all different patient groups until you’re confident there are no gaps in your service.
6. Document the process – both what you did and what you will be doing to address needs – so that you can show the CQC inspectors when they visit.

PPGs or individual surveys can also help in addressing needs. Consider a patient/client that you have been caring for recently. This could be someone who doesn’t have English as their first language, someone with a disability or someone from a deprived socio-economic background. Ask them:

• What barriers did the person face in accessing your service?
• What did you do to help them and facilitate access to your service?
• How can your reflections improve the way in which you or your colleagues deliver your service?

Ensuring all patient groups are looked after effectively and have access to relevant services should be an essential part of how GP practice services are delivered and benefit all patients. As an added bonus, it will also please the inspectors!

How do you ensure you’re responsive to the needs of all of your patients? Do you have any examples you can share with your fellow practice managers? Either comment below or in the forum thread here.

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