Call for "compassion" as Lancashire patient says getting a GP appointment is like "going into battle"

The patient likened the experience to “going into battle” - and said that she often felt like had been subject to an interrogation simply for seeking medical help.

A recording of her recounting her experiences was played to a meeting of the Lancashire and South Cumbria Integrated Care Board (ICB) as part of a regular session during which health service leaders and senior practitioners hear a patient's perspective on NHS services and attempt to learn from it.

It prompted one GP to suggest that everybody who wants to see a doctor on any given day should at least get a phone call from one.

Meanwhile, another board member stressed the need to inject some “basic kindness and respect” into the conversations had between patients and surgery staff at the initial point of contact.

The patient whose story was heard at the meeting - and who remained anonymous - said that she recently steeled herself to call her GP practice after experiencing a raft of sudden-onset symptoms that were affecting her ability to work, including stomach cramps and back pain.

“I felt that they were getting worse, so I rang the surgery hoping for a same-day appointment on my scheduled day off,” she explained.

“I’m quite a confident person, but I always feel really anxious before ringing my GP surgery, because I often have a poor experience when trying to get an appointment. It feels like going into battle before I even dial the number.

“There have been times when I just haven't gone to my GP because the experience is off-putting - even confrontational. Unfortunately, this time was one of the worst.

“From the outset, the receptionist was rude. I fully understand that they have to ask questions - and I don't have a problem sharing details with them - but she didn’t even let me finish my sentences before cutting me off and asking another question.

“It felt like an interrogation rather than someone trying to get the best information from me to help. It made me feel as though I was being stupid and wasting her time.

“In the end, she told me that I couldn’t have a same-day appointment, because I didn’t trigger as an emergency. She didn't even offer me any advice on what I should do next,” the woman explained.

The board heard that after asking to speak to the receptionist’s manager, she was left on hold for ten minutes before another staff member came on the line and booked her three separate appointments for a fortnight’s time. One was to see a GP and another a physiotherapist, but the third was with a mental practitioner - something that the patient had not requested, but was given because she commented that the earlier part of the call had made her “anxious”.

She was even told that the slot with the GP was “on condition” that she attend the other two appointments - and she says she was offered little flexibility over days and times, other than being able to book the first appointment of the day.

“When the call ended, I felt humiliated and not listened to,” the patient said.

She added that while she felt “completely supported” by the GP and all of the clinical staff she eventually saw, she nevertheless thought twice about continuing to pursue a diagnosis after initially inconclusive test results - and as her symptoms had started to settle - because it was tough to find “the motivation to face a potentially unpleasant situation”.

“I’ve had to take a deep breath sometimes just to walk through the door, as it does feel intimidating,” she added.

The consensus around the room was that the story board members had heard was an all-too-common tale.

Professor Sarah O’Brien, the ICB’s chief nursing officer, said that even some staff working in community health services were frustrated about “the layers” that had been added to the process of getting appointments.

“To be fair to the receptionists, we put some of these layers in to try and manage demand, so that people get to the right appointments and the right place, but…sometimes we stick to those processes and don’t listen [to or] don't respect what the person’s saying.

“Basic kindness and compassion and respect for individuals when you’re dealing with them don’t cost us anything - and I think sometimes we clearly see through…poor communication that we lose that,“ Prof O’Brien added.

Back in 2021, a meeting of the ICB’s predecessor organisation heard how levels of “unacceptable abuse” from patients towards reception staff had resulted in some of them quitting their jobs.

GP GUARANTEE?

The board’s GP representative, Dr. Geoff Jolliffe, described the story told by the patient as “terrible” - and something which could not be defended.

However, he added that the broader difficulties in accessing GP services had resulted from "unbearable pressures that have been building up for a long time”, including a workforce shortage and increased demand.

In spite of that reality, Dr. Jolliffe told the meeting that it was “unacceptable for someone to ring up and not get a satisfactory plan”.

“So it might not be [that] you are going to see the GP today, but…[being given an explanation that] this is what we’re going to do,” he said.

While acknowledging that it was not a suggestion that was popular with many of his fellow GPs across Lancashire and South Cumbria, Dr. Jolliffe said that he at least speaks to “every single patient who ask[s] to see me that day”.

“I think if you have senior decision-making right at the very front [of the process]...that helps a lot.

“It doesn't mean you don't have some form of triage first by reception - because…sometimes [people are asking to see a GP] because patients don’t understand other pathways and reception can help the patient understand there are different ways to get what they need.“But when a patient needs to see a clinician, I think they then need to speak to a senior person, usually a GP, to do the triage.”

Barrow in Furness-based Dr. Jolliffe - the partner member for primary medical services on the ICB - said that such a system had workled “fantastically” for him, both before the pandemic and during the earlier periods of it which demanded such an arrangement be put in place.

However, he said that the idea was not popular amongst GPs, because they regarded it as an increase in workload.

“[But] I think you can redirect a lot of work if you do it like that,” he explained.

“It’s not liked by some patients [either], because they feel like they’re not going to…get to see the GP - so there's a cultural thing on both sides of the equation, but we need to work on that.”

WHAT ELSE CAN BE DONE?

There is the potential to find some “really good local solutions” to issues with access to GP services - if primary care leaders and patients themselves are brought together to design them.

That was the message from University Hospitals Of Morecambe Bay chief executive Aaron Cummins.

He said that ongoing transformation work in primary care and community services provided a good opportunity to make the changes that were needed.

Reflecting on the patient story presented to the board, he said that it was an example nobody involved getting a good outcome.

“The receptionist feels under pressure, the patient doesn't get the service they’re looking for [and] the GP gets poor feedback despite working really hard,” Mr. Cummins said.

ICB chief executive Kevin Lavery was one of several members to refer to the government promise of investing in the latest telephony systems to end what ministers have described as “the 8am rush”, but added that, in the case of the patient that had board had heard about, “it’s not really a technology issue, it’s about…people, culture and and service issues”.

He also said that it was important to reflect on the fact that primary care was “a service under pressure” and yet was managing to deliver more services with fewer staff as a result of productivity increases.

Newly-released figures show that there were 600,000 more appointments in GP surgeries across the North West as a whole in November 2023 compared to the same month on 2019, just before the pandemic struck.

Mr. Lavery added that the region had to make the most of the money available to hire so-called “allied health professionals” to work in GP surgeries and provide services alongside doctors.

COUNTING THE COST OF ‘NO SHOWS’

209,000 – number of GP appointmets booked in the North West which patients failed to attend in November 2023

20,000 – increase in the number of North West ‘no shows’ compared to November 2019

£42 – average cost of a standard GP appointment

£8.7m – estimated cost to the NHS in the North West of patients failing to attend appointments in November 2023

Source: NHS England