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When doctor won’t see you now

November 4th 2019

Access to primary care is a hot political topic. Victoria Winckler unpicks some of issues behind the headlines and asks what more can be done?

“Access” to GP services is a hot political topic. There are regular headlines about recruitment problems, long waits to see a GP and numerous phone calls to get an appointment.

The Welsh Government recognises these challenges and is committed to improving access in Taking Wales Forward, has recently announced it will introduce new access standards,  and is actively recruiting new GPs. So is that the problem sorted?

Well, no.

The problem is that “access” means different things to different people. As a result, the Welsh Government can slip and slide between these different meanings, all in the name of ‘improving access’.  At worst, nothing improves because everybody’s working to their own understanding of ‘access’.  If the public means having to wait 4 weeks for an appointment while the Welsh Government is busily making surgeries wheelchair accessible, we have a problem.

In our forthcoming work with Age Alliance Wales, we found that at its most basic, access means having a GP – and ideally a choice of GP – to register with. This is harder than you might think. Across Wales, and especially in north Wales and the valleys, GP practices have been merging or even closing completely. Even those practices which remain are increasingly closing their lists temporarily because they feel they have too many patients.

Access to GP services also means the practice being open to see people. This is what access means in the Welsh Government’s statistical bulletin on ‘access’.  This shows that just over half of practices are open 8.00 to 18.00, although the proportion is lower in north Wales (39%) and West Wales (41%).

Yet another take on “access” is how easy it is to contact your GP surgery, e.g. by phone or online. This is what access seems to mean in the Welsh Government’s Access Standards, with its references to practices having telephony systems in place to avoid patients ringing dozens of times to get an answer. This is one of the main factors in whether or not patients are satisfied with their GP.

And then there’s access as whether or not a patient can see a GP when they need to. Very often decision makers think this type of access means an appointment in 24 hours, and so they have prioritised speed. However not all consultations need to be same day – in fact for many  long-term health problems what matters is not speed but continuity of care.  The evidence shows that continuity is not only preferred by many patients but has better health outcomes too. So speed isn’t the only issue.

Last but not least, GP practices need to be accessible for people of all abilities. Phone appointment booking systems aren’t necessarily any help to people with hearing impairments, nor are upstairs consultation rooms accessible to wheelchair users. As our work with Age Alliance Wales will show, there were some very concerning examples of disabled people being denied access to a GP.

What can be done?

Increasing the number of GPs especially in shortage areas is important but it’s only part of the solution. So too is improving telephone systems, but it’s not much help for deaf people.  So what can be done?

For a start, politicians and professionals need to be clear what they mean when they talk about ‘access to primary care’.  What exactly do they mean by “access”? Opening times? Appointment booking? Or being wheelchair accessible?  And how are they balancing the availability of same-day appointments with continuity of care?  And just how are they ensuring that everyone, including older people and disabled people, can access GP services?

Look out for our report for Age Alliance Wales for more practical solutions – to make sure you get it why not join us and get it straight to your inbox?

Victoria Winckler is Director of the Bevan Foundation

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