Major discrepancies in patients’ experience of access to GP appointments in Hastings and St Leonards are revealed by an independent survey undertaken by Ipsos Mori on behalf of NHS England. It was released earlier this month by Healthwatch East Sussex, a community interest company which reports patient feedback to the NHS. 

The survey was conducted between January and March this year, covering over 8,000 practices throughout England. Among 18 separate questions, patients were asked how easy it was to contact their registered practice by telephone; about their experience of arranging appointments, whether in person or remotely; whether they were able to speak with the individual GP of their choice; whether they felt their case was given sufficient time; whether they had confidence and trust in the healthcare professional who dealt with it; and whether the overall experience was “good” from their point of view.

Carisbrooke Surgery: 100% trust and confidence
CREDIT: Dave Young

Both nationally and locally, the vast majority of GPs scored highly on the level of trust and confidence which they instil in patients. Nationally, 96% of patients confirmed this was the case at their most recent appointment; the same percentage applied on average to all the practices within the East Sussex Clinical Commissioning Group (CCG) covering Hastings, Eastbourne, Lewes and surrounds. Within Hastings and St Leonards, only Warrior Square surgery (84%) fell significantly below, while the Carisbrooke practice was given a 100% rating.

Equally, the great majority of practices were credited by over 90% of their respective patients with meeting their needs at their most recent appointment. Lowest figure within the borough was Station Practice at 87% while Carisbrooke and Churchwood topped the poll at 98%.

Comparing access

Comparisons of the ease of accessing a practice by telephone, the probability of being offered an appointment with a preferred GP, and of having a ‘good’ experience of arranging the appointment, were, by contrast, starkly differentiated. Carisbrooke scored 88%, 66% and 87% respectively on these criteria, while Warrior Square managed just 22%, 19% and 34%; at Station Practice only 15% reported being able to speak with their preferred GP.

These results are not in themselves surprising. Most of the larger practices in town, including Station Practice, High Glades and Warrior Square, are serviced by doctors on short term contracts or locums. They have necessarily less familiarity with their patients and are less likely to make themselves available beyond their contracted hours. Managers have calculated that a model of operation which limits patient access and choice is more profitable. 

Station Practice premises
CREDIT: Dave Young

The effect on patient experience is, however, equally unsurprising. The final question in the survey asked respondents whether they would describe their overall experience of their GP practice as “good’”. The national percentage is revealed as 83% and for the East Sussex CCG 85%. Within Hastings and St Leonards, Carisbrooke was credited with 96% and Harold Road surgery 90%. But Warrior Square scored just 59%, Station Practice 70% and High Glades 71%.

Who cares? 

Healthwatch East Sussex is the brand name of East Sussex Community Voice CIC. Their website states that they “gather people’s views of health and social care services in the county and make sure they are heard by the people in charge. The people who fund and provide services have to listen to you, through us. So, whether you have had a good or bad experience, your views can help to make changes to services in East Sussex.” 

But how exactly? Is the release of the survey figures designed to increase competitive standards between practices? It cannot do so on the basis of supply and demand, given the barriers which the CCG puts in place to prevent patients moving from one to another. 

An alternative could be the imposition of sanctions on low-scoring practices by the Care Quality Commission (CQC). But that’s hardly likely to happen either. It is arguably the CQC’s own preference for rationalisation of management, including increases in size of practices and diminution of doctors’ roles within them, which is driving the reduction of access which patients have experienced and reported.

NHS Guidance

So what other options are open to patients who have difficulties in accessing their GPs? Going straight to the pharmacy may cut the wait, but in an area with a high proportion of residents who are exempt from prescription charges there’s bound to be a preference to get the drug fix by a route that doesn’t cost. The NHS is keen to promote its online services: 111 First, which is aimed at providing a first port of call for urgent and emergency care, and Engage Consult, which offers non-emergency engagement. But the fact is that many, perhaps most, people who are sick or injured want face-to-face rather than remote appointments and, if these are not readily available from GPs, they will resort, says Healthwatch, to A & E.

NHS England knows this too, and in May this year issued guidance to all GP practices, instructing them that they should “respect preferences” for face-to-face care “unless there are good clinical reasons to the contrary” (such as the patient displaying Covid symptoms). They were also told to open their reception areas to walk-in patients.  ‘While the expanded use of video, online and telephone consultations can be maintained where patients find benefit from them, this should be done alongside a clear offer of appointments in person.” Any denial of such access would, according to NHS England, “exacerbate health inequalities”.

It remains to be seen what effect, if any, the publication of the survey will have. Sussex NHS Commissioners, who commission GP services across Sussex, have said: “Feedback from the public about access to health services is important in ensuring we continue to make changes and improve information and routes to access, in order that people can get the right care, in the right place at the right time – and in a way that works for them.” 

Dr Craig Namvar, managing partner of Hastings & Rother Healthcare which runs the Warrior Square surgery along with the Old Town Surgery and Churchwood Medical Practice responded: “Unfortunately these surveys don’t really reflect the reality of things”.

A full view of survey results for every GP practice is available at https://gp-patient.co.uk


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