Principles for access to General Practices
The Scottish Government commissioned us to conduct discussion groups and a Citizens’ Panel survey to gather patient and public views on a draft set of principles for access to General Practices.
Access to general practice services is to be a highly emotive subject and has been for many years. It is a topic of discussion by all health and social care staff, patients and service users, their families and carers, wider society, politicians, policy makers and the press. A common definition of what access is or what it should deliver can be difficult to achieve. ‘Appropriate access’ does not tend to be readily understood. On the back of a pandemic that changed practice processes, it is sensible to consider exactly what general practices should aim to deliver from a resource limited, but critically important, part of the NHS in Scotland.
The Scottish Government set up a General Practice Access working group that met for the first time in November 2022. The aim of the group was to develop a set of principles about access to primary care services, which captures the views of general practice staff, clinicians, health boards, health and social care partnerships, professional bodies, other key stakeholders, and people.
A workshop was held in December 2022 by the Scottish Government to start developing those principles where it was agreed what was to be included and excluded. This has been applied to this Gathering Views exercise. Within scope: all general practices across Scotland and all patients, people and citizens. Outwith scope: the needs of special groups, finding answers and solutions to access and fixing demand and capacity in general practice.
The Scottish Government commissioned us to conduct discussion groups and a Citizens’ Panel survey to gather patient and public views on the draft set of principles. This took place during March and April 2023. This report contains a summary of the key findings from both the discussion groups and the survey.
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File size: 560 KB
Publication date: October 2023
Feedback from discussion groups
We gathered people’s views using a mix of face-to-face interviews and group discussions. In total, 30 people shared their feedback. People were recruited from community groups including Patient Participation Groups in Tayside and Ayrshire, Coll Collaborative Group, NHS Western Isles Patient Panel, South Lanarkshire Health & Social Care Forum and Chance to Change Group (Glasgow)
When participants were asked what mattered to them about accessing a general practice, they said it was important to be able to contact “the right person” and being able to speak to someone or access services when they needed to. They stressed the importance of getting “timely support” whether that be from the general practitioner or another member of the multi-disciplinary team. There were issues raised about timely access via telephone, appointment availability and concerns about confidentiality.
Participants discussed what good access would look like and compared this to where it would, in their opinion, fall short.
Participants considered the Scottish Government’s draft principles and overall they felt that they were positive and much needed. There was some feedback about accessibility and the language used and this is documented in the full report. Each of the principles was considered in turn and the feedback captured.
Participants generally felt the principles were “good, clear, concise and easily understood”, providing some of the terms and wording was changed to add clarity. However, some participants felt the principles were “too clinical and operational” and questioned whether they would be meaningful to all patients. They also felt that implementation of the principles needed to be monitored in some way and there shouldn’t be a reliance on patient complaints to assess whether or not they were working. Participants expressed the need for choices for accessing services should be more available for everyone and recognition that not all patients had or could access a telephone or IT facilities (for example, some older people).
Some participants said that it was “quite disheartening” to know that ways of working were not as described by the principles already. They felt the principles needed to be in Easy Read and Plain English and others wondered whether they were aimed at professionals or patients because of the way they were currently worded and possibly not easily understood by patients.
Within the discussion participants considered what a practice meeting all the principles would look like and said that it would be one which was “accessible, equitable, flexible, inclusive, responsive, approachable, welcoming and non judgemental”.
Participants felt there was a need to encourage health professionals to demonstrate the benefits of multi-disciplinary team working within primary care and moreover patients needed information about “who does what” within the practice – one participant said that a lot of people don’t understand who the different staff were nor how to access them.
Whilst the discussions centred on gathering views on the draft principles, it was clear that there was an appetite to discuss how people can access general practice services more generally and a real willingness to share their experiences.
Feedback from Citizens’ Panel
A survey was sent by email to all 938 Panel members whom we hold email addresses for. A total of 449 responses (48% response rate) were received by email. This level of return provides data which is statistically robust at national population level and representative of sex, age, deprivation and housing tenure.
The survey opened by asking respondents what they believe matters most when accessing their general practice. Most important to Panel members was being able to access appropriate care in a reasonable time (45%), followed by a reliable appointment system (31%) and appointments with appropriate healthcare practitioners (26%).
When respondents were asked for their opinions on the 3 principles to accessing their general practice and whether they agree or disagree with them:
- Almost all respondents agreed or agreed strongly with each of the principles with respondents being most likely to strongly agree that access to general practice for people should be easy, clear and fair and at a time in keeping with need (89%)
- Slightly fewer respondents strongly agreed that general practices should help people to get seen by the best and most appropriate person to see them (85%) or that people should have a reasonable choice about how they access services, and that services should be approachable, sensitive and considerate to needs (77%).
Panel members were shown a list of principles and statements and asked which were most important to them. The 3 principles which were identified as being most important were:
- When appointment availability is limited general practices should ensure that those with the most urgent care needs are met (72%).
- People and general practices should have a positive and trusting relationship (66%).
- People who live with frailty and health needs must have a known and trusted member of the general practice team aligned with their care (60%).
The majority of Panel members (59%) agreed fully that the principles were clear and understandable and a further 38% agreed somewhat. Only 3% disagreed that the principles were clear and understandable and 1% were unsure.
Those who said the principles were not clear or understandable were asked how these could be improved. Around a third of comments were where respondents felt the principles should be clearer (33%), and a further 21% felt they should be understandable to everyone. Other suggestions were for examples to be provided on what the statements mean (18%) and where they questioned what the statements mean in practice (17%).
All panel members were asked if there was anything else they would like to see included in the principles or statements. Over half of respondents who answered said there was nothing else they would like to see included (54%). The most common suggestions were regarding lengthy waits for appointments or on the telephone (10%), accessing appropriate care (9%) and regarding the role of receptionists as gatekeepers (6%).
Finally, Panel members were asked how they think general practices should raise awareness of when patients should use the services of the multidisciplinary team rather than the GP. The most common response was for information to be provided on the general practice website (54%) and this was followed by information made available at the general practice, for example via leaflets or posters (50%) or directly from the receptionist (44%).
Based on the feedback, we recommend that:
- General practices across Scotland are encouraged to increase the involvement of patients in changes to services.
- General practices look towards the development of new ways, systems and processes for capturing patient experience particularly in the design of services and change ideas.
- As a matter of course, general practices use the Scottish Government's principles when engaging with their practice population.
- We consider whether a further Gathering Views exercise on access to general practice services would be beneficial in the longer term.
The feedback gathered from the public has informed the content of the final report of the General Practice Access Short Life Working Group, which was published on 23 November 2023.
The importance of people's views and comments is described in the Preface:
"The work of the Healthcare Improvement Scotland (HIS) Community Engagement Team in facilitating focus groups and their Citizens’ Panel has been extremely important and helpful in developing the principles.
"It is important to note that from the HIS Community Engagement Report the public described their ideal General Practice as: “accessible, equitable, flexible, inclusive, responsive, approachable, welcoming and non-judgemental.”
"We believe this is what everyone working in and with General Practice and the wider healthcare system would hope for and aspire to."