Is an instant GP appointment what people really want?
Greater flexibility and less of an inquisition from reception staff are what’s more urgently needed
The Labour Party has decided that primary health care is an election issue, with Ed Milliband promising a GP appointment within 48 hours.
But is an instant GP appointment what people really want?
New research into women’s access to primary care suggests greater flexibility in making appointments and less of an inquisition from reception staff are what is more urgently needed.
There is no question that many people are waiting longer for GP appointments than they would like. The Royal College of General Practitioners found that for one in six appointments during 2013, people had waited more than a week to see a nurse or doctor.
For some people, these delays pose a risk to health and result in avoidable visits to A&E or out-of-hours services, increasing costs for the NHS as well as frustration amongst users.
For the women taking part in the Maternity Action-WHEC study, Women’s Voices on health: addressing barriers to accessing primary care, the problem starts in the choice between same day appointment or appointments several weeks away. Few surgeries appeared to offer appointment a few days ahead, creating problems for women who couldn’t drop everything to chase a same day appointment.
For women with caring responsibilities, the impact is particularly harsh:
“…the wait for a non urgent appointment is 2-3 weeks. [Otherwise] patients are required to turn up in person at the GP surgery at 8am to book an urgent appointment which will be at any time during the day requiring 2 trips – this is completely inhumane as a mother coping with ill children.”
The difficulties in arranging appointments in advance, and the limited times available, meant that three quarters of the mothers surveyed usually take their children with then when they have a health appointment. The presence of children affects what women can discuss with their GP. Health appointments are significantly less effective if women feel unable to raise questions of mental health, sexual health and domestic violence because their children are in earshot.
Women objected to having to give the reason for the appointment to the receptionist and, in some cases, having to persuade the receptionist that the appointment is needed. Women found this was a deterrent to seeking an appointment and, for many, it raised serious issues of confidentiality. As one woman living with HIV said:
“Receptionists can be aggressive and ask intrusive questions while you are in the queue with other people listening. You are already tired and sick so you lose it and have an argument.”
Given the rising cost of living, it was not surprising that fees and expenses associated with attending GP appointments affected women’s decisions to see their doctor. What was unexpected was that almost half of the women surveyed raised this question, demonstrating the pressures on middle as well as lower income families.
41 per cent of women reported taking pharmaceutical charges into account when deciding whether or not to make an appointment with their GP. For 23 per cent of women, the cost of travelling to the appointment influenced their decision.
Worryingly, the research found that vulnerable women are still struggling with basic questions of access.
A focus group with refugee and asylum seeking women heard that women had been refused registration because their identity documents were not accepted and that they regularly required help from social workers and other advocates to make appointments as reception staff kept referring them on to A&E and walk-ins. In a focus group with women with learning disabilities, women reported being confused by complicated registration forms but refused help to complete them by reception staff.
Focussing political attention on the difficulty of getting GP appointments is welcome, as this is clearly an area requiring some work. The quick-fix model of immediate appointments is, however, an incomplete answer to a much more complex question.
Simpler registration procedures, a mix of online and telephone booking arrangements, and significantly more choice about appointment times would do much to alleviate the pressure on the health system and improve the experiences of those who use it.
Rosalind Bragg is director of Maternity Action
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