Sarah Rochira sets out the findings of her report into older people’s experiences in accessing and using GP services
Older people in communities across Wales rely upon their GP services to provide them with high quality, safe, timely and effective health care close to home, and to support their access to a much wider range of health and social care services.
However, my new report ‘GP Services in Wales: The Perspective of Older People’, published on Tuesday, found that there are significant and unacceptable variations in older people’s experiences of accessing and using GP services in Wales.
Over 1,600 older people across Wales shared their experiences with me, and I also took evidence from a wide range of stakeholders across the public and third sectors.
A number of older people spoke in positive terms about their GP services, and there is an understanding of the current pressures within GP services and primary care. However, while it is clear there is much work underway to deliver improvements, there are a number of particular issues that simply cannot be ignored.
For too many older people, making an appointment is challenging, inflexible and unresponsive to people’s individual needs and circumstances. A variety of booking systems were used by different surgeries, ranging from frustrating telephone systems that required endless redials, to unacceptable examples of people being forced to queue up outside a surgery, often in poor weather, to ensure they could get an appointment. Once an appointment was secured, the surgery itself could be a barrier for older people, in terms of its accessibility via public transport, for example, or the design of the surgery environment.
Continuity of care – which is often central to the confidence and trust between older people and GP services and helps positive relationships between an individual and a professional – was also highlighted as an issue. Older people understood that it would not always be possible to see the same doctor, but in many cases continuity is essential to deliver better outcomes, particularly for people with multiple or chronic conditions.
Related to this, a number of older people told me that their GP service is not sufficiently aware of, or responsive to, their individual communication needs and that limited time for appointments and/or the ‘one issue’ rule often made them feel under pressure and unable to discuss all that they needed.
The issues described above were particularly pronounced for people living with a sensory loss, those with dementia or a cognitive impairment, and for carers, and it is clear that far more needs to be done to ensure that their needs can be met by GP services across Wales.
My report also found that older people who wish to access GP services in the Welsh language often experience delays due to the lack of availability of Welsh speaking professionals, something that echoes the findings of the Welsh Language Commissioner’s 2014 inquiry into the use of the Welsh language in primary care – ‘My Language, My Health’.
As our Primary Care services in Wales have evolved to account for the shift towards preventative and prudent healthcare, a number of alternatives to traditional GP services, such as a greater use of practice nurses and community pharmacists, have been established and promoted, although this is not consistent across the country. Whilst those who had accessed these services reported positively on their experiences, many older people were simply not aware of their existence and therefore do not have the necessary support needed to access them.
Finally, as is the case in so many of the services that people may rely upon as they grow older, many older people reported that they find it difficult to provide feedback, raise a concern or make a complaint about their GP service, with perceived implications about the impact that doing so would have on their future access and treatment. Addressing concerns and complaints is vital in driving improvements within services and it is essential that people are not discouraged from providing this feedback due to a fear, whether real or perceived, of potential repercussions in doing so.
The issues set out above create challenges and barriers that could discourage older people from accessing primary care when they need it most, and even push some into accessing less appropriate unscheduled care options, such as out of hours or accident and emergency services, creating additional pressures on other parts of the health system.
Furthermore, as touched upon above, policy aspirations are aiming to deliver more care in the community, and involve individuals in co-produced decisions about their health care. There is a real risk that the concerns that older people have raised about communication and time could jeopardise the degree to which they are able to have a say in decision making.
It is vital, and my expectation as Commissioner, an expectation that older people and their families across Wales will share, that those who design and deliver health care services will listen to, learn from and act upon the older people’s voices within this report.
I have therefore published formal Guidance for Health Boards alongside my report, under Section 12 of the Commissioner for Older People (Wales) Act 2006, which they must have regard to when discharging their functions. The Guidance sets out what ‘good’ GP services look and feel like to older people, and provides good practice examples, while also providing valuable self-scrutiny questions that Health Board Members, service directors and practice managers can use to evaluate service delivery and inform continuous improvement.
While there will be challenges in delivering this change, a failure to address the issues highlighted in my report will have a significant impact not only on wider health services and the public purse, but more importantly on the health and wellbeing of older people across Wales.
It is therefore vital that action is taken to ensure that the good practice already underway, reflected throughout my report, becomes the standard across Wales, so that all older people, wherever they live in Wales, can have positive experiences when accessing and using GP services.