We need primary care services fit for our changed society John Tingle

T

he Patients Association is a campaigning charity, listening to patients and speaking up for change. It has been working for nearly 50 years to make sure that the patient’s voice is listened to by policy makers.

The Patients Association report The responses collated and analysed for the report are based on two polls and a survey that the Patients Association distributed to its members and e-supporters. It received a total of 3076 responses. The 2013 report states that as many as nine out of every ten health and social-care interactions with the NHS will take place at the primary care level. But difficulty in getting or attending an appointment is creating a system plagued by avoidable delays.

Changing society, changing services One in five (21.7%) respondents stated that they had to take time off work to attend a GP appointment. When weighted against those of working age (16–64 years old, as defined by the UK Census 2010) who responded, that figure almost doubled to two in five (38.2%). Of those who had to take time off work to attend appointments, over half (58.2%) had to take a whole day or longer. The report states that the provision and availability of primary care diagnostic services must become more flexible to reflect the changing responsibilities and work patterns of contemporary society.The current system, the report argues, is designed around an outdated idea of what constitutes a traditional working day and does not allow for the proper application of reasonable choice—especially with regard to where an individual person can go to access advice and/or treatment. The report states that in an era of austerity, and at a time where a productive and available workforce is intrinsically important to our nation’s future, a system that requires individuals to take time off is flawed. What is needed is a focus on the design and promotion of networks of integrated care services that allow people to access health facilities with ease.

Out of hours care: a story of decline? John Tingle is Reader in Health Law, Nottingham  Law School, Nottingham Trent University

846

The report found that over half (54.8%) of the people surveyed were not satisfied with the service they received from an NHS out-of-hours provider in the last two years. When asked, “Would you feel safe relying on the NHS out-of-hours service for a

potentially urgent medical problem?” over three-quarters (79.2%) of those responding stated that they wouldn’t, or that they didn’t know. The report suggests that, unfortunately, this situation is getting worse. As a result of the 2004 reforms, we have changed from a simple system based on an almost universally understood and available method of provision, to an increasingly confusing labyrinth consisting of a multitude of providers, offering differing services of widely disparate quality. As a consequence, the report states, NHS out-ofhours provision has suffered a severe loss in public confidence and has become one of the most sporadically available services available on the NHS today. Health care is something that is required 24/7 and rarely works around a convenient schedule. The report points out that the inability to access GP services out-of-hours and at weekends makes for a care lottery that often gets compounded by the lack of consultant-led care available to acute centres, A&Es and hospitals, especially at weekends. The report quotes figures from 91 primary care trusts, obtained by the Labour Party earlier this year under the Freedom of Information Act, which showed a fall in the number of surgeries offering extended opening hours in half of NHS trusts. Nationally, the survey suggested there had been a 5.7% decline in surgeries offering weekend and evening appointments, equivalent to 477 surgeries serving more than 2 million patients across England. In April this year, the commissioning and regulation of GP services changed substantially. GPs are now required to take a proactive role in the commissioning of services within a structural framework consisting of multiple Clinical Commissioning Groups (CCGs). They do this under the auspices of the new NHS Commissioning Board (now called NHS England), with the quality of their care being regulated and inspected by the Care Quality Commission (CQC).

Patients, not professionals Despite all these changes to out-of-hours care, the report argues, little attention or reflection has been given to the audit or reform of the system. In addition, the continuing consultations and ongoing negotiations on a proposed new GP contract indicate that the system is in dire need of appropriate support and management. The report states that the increasing number of calls that the Patients Association helpline is receiving indicates that there is an urgent need for a proper review and public consultation on the future development and provision of out-of-hours care. If the system is to offer a sustainable service that is fit for purpose, it must be designed to benefit patients—not shaped around what is easiest for healthcare professionals. The Patients Association concludes:

© 2013 MA Healthcare Ltd

John Tingle discusses a report from the Patients Association on provision of and access to primary care services.

British Journal of Nursing, 2013, Vol 22, No 14 © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 154.059.124.102 on September 19, 2016. Use for licensed purposes only. No other uses without permission. All rights reserved.

patient safety “It is our opinion that the system is: desperate need of review; ■■ Has had little support in the promotion and fomentation of best practice or the introduction of statutory provisions designed to create and ensure the adoption of a basic minimum of service; and ■■ Requires standardisation of service through a clear, coherent and concise public awareness campaign on what services should be expected and how these should be made available.” ■■ In

© 2013 MA Healthcare Ltd

Vote of no confidence in NHS 111 The report states that: ■■ Fewer than one in ten (80 (8.1%) out of 984 who answered) of respondents stated that they felt that NHS 111 (which is replacing the NHS Direct helpline) would be an improvement on their current out-of-hours service ■■ Over half (59.7%) of respondents did not consider the outof-hours services currently available to be better than those that were available under General Practitioners (pre-2004) ■■ Nearly three out of four (72%) respondents were either unable to make contact with a doctor or were unsure if they had spoken to one. The report states that despite the delay in getting NHS 111 up and running, there remain many issues regarding the standardisation of the service, and the public’s confidence in and willingness to use the service. Anecdotally, the Patients Association has also heard and seen evidence of confusion as to the purpose of the service as a result of NHS 111 often being advertised alongside a number for a local GP out-of-hours service. Additionally, the Patients Association have heard and researched instances where the NHS 111 service is automatically referred to if an out-of-hours service is unavailable. Many of those who have used NHS 111, the report fairly points out, found it useful, with the support and advice given providing necessary reassurance or clear information as to the appropriate course of action—when it was provided by a healthcare professional, that is. But like so many other NHS health and social-care services, the report found NHS 111 to vary in quality. Specifically, many calls were perceived not to be answered by healthcare professionals, but by people basing their reponses on a pre-existing script and/ or pathway, who lacked the ability to give specialised advice (e.g. maternity or mental-health advice or referral). This anecdotal evidence, the report informs us, is backed up the recent survey of NHS 111 services that showed that clinical staff were handling only an average of 29% of calls received. Yet, the range of data showed a wide difference between individual sites, ranging from 46% of calls being answered by clinical staff, to just 2%. It’s no surprise, then, that respondents reported that their confidence in NHS 111 had been marred by a seeming tendency for the service to recommend patients to A&E and out-of-hours services, often unnecessarily, thereby undermining the purpose of the NHS 111 service in the

British Journal of Nursing, 2013, Vol 22, No 14

first place. This confidence is important: it directly affects the public’s use of the service, as well as the likelihood of the advice being fully adopted by the caller.

NHS 111: key survey findings ■■ Few

are aware of how to use NHS 111 is little to no confidence in the service ■■ Mistrust seems anecdotally to come from the view that NHS Direct, NHS 111 and other telephone-based “triage services” are attempts to cut services rather than make them more efficient ■■ There is strong support for better, person-delivered, community-based services to replace NHS 111 ■■ There are fears of confusion in relation to locally available services. Local out-of-hours services, especially private ones, often advertise a local or non-freephone contact number, sometimes along with the NHS 111 number. ■■ There

Calls to action The Patients Association ‘calls to action’ for primary care are: ■■ The NHS Commissioning Board should review emergency care across sectors, not just at A&E departments but also at primary care level, to reduce costly admissions and keep care local ■■ The Government, the NHS and GPs need to work together to expand choice and access to primary care services by addressing barriers to appointments, both during and outside office hours. People should have the right to choose any GP surgery based on their needs, not on restrictive geographical boundaries ■■ CCGs should lead in delivering better local awareness campaigns to help improve patients’ understanding of when to use the range of services available, such as: Urgent Care Clinics, walk-in centres, NHS 111 and NHS Direct.

Conclusion The Patients Association report provides a very welcome common-sense critical appraisal of primary care provision and access. It is very worrying that almost four out of five (79%) people wouldn’t feel safe relying on NHS out-of-hours services in a medical emergency. Worrying, too, is the finding that almost two-thirds (61%) of people have to wait longer than 48 hours to book an appointment with their GP and more than half (57%) said the process was either ‘very difficult’ or ‘could have been easier’. That more than a third (38%) of people have had to take at least one day off work to attend a GP appointment is yet further cause for concern. Common sense tells us that there must be a simpler and more effective way of dealing with the provision of and access to primary healthcare services. The experience of patients highlighted by the Patients Association point to a system that is stuck in the past and must change if it is to meet the needs BJN of a changed society. Hall, C (2013) Primary Care Review Vol. II. Primary Care: Access Denied? Patients Association, Harrow, Middlesex. http://tinyurl.com/osy3nxy (Accessed 15 July 2013)

847 © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 154.059.124.102 on September 19, 2016. Use for licensed purposes only. No other uses without permission. All rights reserved.

We need primary care services fit for our changed society.

We need primary care services fit for our changed society. - PDF Download Free
350KB Sizes 0 Downloads 0 Views