Much has been made – both within the primary care sector and by the media – about general practice. Extended opening times, the changing practice workforce, levels of care… but what do patients, arguably the people that matter the most, think about general practice? Practice Index interviewed a trio of patients of different ages and from different parts of the country to hear their views – and then asked for responses from a practice manager.

Views on extended opening hours…

Patient 1: “Something has to be done to make general practice more service-driven. After all, it is a service. Working hours are changing, work commutes seem to be getting longer as house prices force people to live further from work and workplace pressures are greater than ever making it harder to take time off for appointments. Evening opening and more appointments on Saturdays would be great, especially for those non-urgent visits to doctors or practice nurses – but I don’t think it has to be a seven-day service. It’s all about flexibility, balance and the need to evolve the service.”

Patient 2: “Practices or GPs don’t need to add more appointments – they just need to offer them at different times. Reduce the numbers offered in the afternoon and put more on in the evening or early morning. Maybe it’s a simplistic view and I don’t know the rules and regulations, but that’s what I would do!”

A PM’s response: “This is something most practices are looking into, if they haven’t already implemented something. Research does suggest that the public doesn’t back, need or utilise Sunday opening, and practices are restrained by GP availability, but I agree that flexibility and extended hours can be helpful, including to practices when it comes to attracting people to services such as the winter flu jab.”

The use of technology for appointments…

Patient 1: “While a Skype or telephone call would help me – in as much as I wouldn’t ned to take time off work, for example – I’m not convinced it would save practices time. Some kind of tech-led triage could reduce face-to-face appointments but the calls would still take time – and I could see many of those calls ending up with ‘you’ll have to make an appointment to see me’.”

Patient 3: “I really like being able to book an appointment online. It’s a really useful service as it gives me the opportunity to see what’s available and with who. I can also book when I want and I’m sure it reduces the pressure on receptionists.”

PM: “The jury is definitely still out when it comes to telephone triage or video calls and the experience in my practice does back up your claim that many patients end up having to make a face-to-face appointment. No doubt the use of technology and different touchpoints will continue to be looked into but at the moment I think many, if not most, practices would agree the best solution is still to be found. We like online bookings too – and we’ve worked hard to balance the number of pre-bookable appointments with those saved for the day itself.”

Receptionists…

Patient 3: “While I accept that it’s a hard job, why do receptionists have to be so curt from the moment they answer the phone? A bit of courtesy and the ability to ask the right questions about a patient’s needs would surely help both the practice and the patient by separating those truly in need from time wasters or those with non-urgent issues. Again, practices deliver a service – and that starts with the receptionist.”

Patient 2: “Receptionists need to listen more, and not put up barriers. I’m flexible about when I can visit and which GP I can see – but the receptionists just seem to have this pre-conceived idea that you won’t be helpful. Getting past the gatekeeper is the most stressful part of any contact with my GP!”

PM: “The receptionist’s role is a tough one because it’s virtually impossible to please all of the people all of the time. Some people some of the time has to do, given the resources available. The more courteous patients are, the friendlier receptionists will be but it’s fact that they have to deal with some unpleasant people. That said, we do try to encourage a less combative approach and have invested in training, which has worked for us – reviews are much more positive – so maybe that’s something other practices should consider. Just encouraging them to smile while talking on the phone makes a world of difference.”

Levels of care…

Patient 2: “Under difficult circumstances such as budget restraints and the well-documented GP shortage, I think the level of care offered in this country is superb. Once you’ve managed to get an appointment that is! GP practices are the foundations of our health service, so the NHS really needs to protect it better.”

PM: “I totally agree. The most recent NHS patient satisfaction survey said that primary care was the side of healthcare patients thought most highly of. General practice delivers 90% of patient care in the NHS, but its share of the NHS budget fell to just 8.4% last year – a record low. The RCGP has estimated that there is a current shortfall of 3,300 GPs in England and that 8,000 GPs will be needed by 2020 to close this gap. Unless something changes, maintaining this high quality care will be impossible.”

Extended appointments…

Patient 2: “Given the difficulties of getting an appointment and a desire to avoid dealing with the receptionists, I think longer appointments – and the ability to cover more than one problem in an appointment would be brilliant and save everybody time and effort. Surely this would reduce the admin burden on practices in some way? It would certainly make visits seem less rushed and provide the opportunity to discuss complex matters in the depth required.”

PM: “There are plenty of ideas surrounding this floating around at the moment and it’s something we’ll look into at my practice. Feedback from our PPG says it’s demanded too.”

The value of ‘other staff’…

Patient 3: “I would welcome more input from a pharmacist, for sure. I think they could treat a high percentage of patients without the need for a visit to a GP. I also think nurses, especially senior ones, have a role to play in modern general practice and should be given more responsibility.”

Patient 2: “I would say I only need to see a GP about 60% of the time I visit my surgery. The rest of the time I’m sure a nurse or pharmacist could deal with my enquiry. If they’re unsure perhaps then they could refer me to a GP.”

PM: “Again, without wanting to sound like a broken record, this is something we’re looking into. The idea of utilising the skills of a pharmacist is a popular one and evidence suggests they can actually pay for themselves through better medicines management. The GP crisis is forcing us to look at different ways of staffing a surgery – it would be wrong if a practice manager wasn’t thinking about it, given the problems recruiting new GPs.”

PPGs and communication…

Patient 1: “I saw a poster about the PPG in my surgery when I was there recently. But guess what – the meeting were all in the middle of a working day. How do practices expect to attract a wide cross-section when they exclude anybody that works? Therefore they’re ineffective and just become a box-ticking exercise.”

Patient 3: “What PPG? I’ve never seen or heard anything about one at my practice. I actually think communication in general is really important. Yes, I was given a little booklet when I joined the practice but that was over a decade ago and I’ve had no communication since. What are the latest updates from my practice? What are the current opening times? Have the doctors changed? What additional services are being offered? How can I get out of hours treatment if I needed it? I have no idea!”

PM: “While most of this information is online, what prompts are there to encourage patients to look at the info? And not everybody is online! Therefore, more paper communication is probably required – certainly it is in my case, so it’s something I’ll look into. Social media has a role to play too. Regarding PPG meetings, we’re looking at the idea of ‘virtual’ online PPGs in order to attract different demographics and encourage more anonymous comments.”

The practice environment…

Patient 2: “I really can’t complain. It’s always very clean, tidy and functional – and that’s what you want it to be. Some more up-to-date magazines would be good! I like the electronic check-in system and the new community noticeboard throws up some useful information too – both of those relatively recent additions that have improved the practice.”

PM: “This is always tough to get right as there’s so much to think about, not least hygiene. We tend to refer to CCQ inspection reports for feedback – as is the CQC mythbuster series, which gives some handy hints regarding what the inspectors are looking for.”

What do you think about the views above? What other topics would you like us to cover in a future interview? Let us know by commenting below in the Practice Index Forum thread here.

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