Primary Care Pathfinder – discovery report

GP surgery staff spoke of a public perception (validated by research with citizens, among other sources) that GP surgeries were not seeing anyone face-to-face, when in fact they “never closed their doors”.

Practices described how the pandemic had changed how they handled appointments in the following ways:

Pre-pandemic:

• most appointments were conducted face-to-face, although some practices had moved to a telephone-first model (described in section 5.3) to better manage demand
• online bookings were often available for all kinds of appointments (bookable in advance) and some raised issues around citizens booking the wrong appointment to get a “foot in the door”

During the pandemic:

• all appointments became telephone-first triages for infection control reasons – only carrying out in-person consultations later with those who needed them and did not have COVID symptoms
• practices that resisted telephone consultations pre-pandemic discovered that they could do more than they thought through telephone consultations – so it is now as much about managing demand as it is about infection control
• most practices stopped using online bookings when the pandemic began because of the move to a telephone-first approach, the need to control who comes into the practice and planning capacity in advance

Looking ahead:

• some practices are slowly moving back to opening online bookings for routine and health campaign generated appointments, such as reviews, smears, and flu vaccinations
• there remains some concern that citizens will continue to book into the wrong type of appointment – one practice solves this by someone checking routine appointments to ensure that only those eligible are booked in and, where not, contacting those individuals to make alternative arrangements
• there is recognition of the need for a blended model that gives citizens choices about how they interact with their practice

‘Changes without explanation’

Experiences from citizens highlighted how, in their view, practices had introduced changes without attempts to explain or raise awareness about how new systems worked.

Some people were looking for reassurance that using new channels (a digital tool, for example) would not put them at a disadvantage to those using the phone. Where in doubt, they would try all or any channels they could.

Some people managed this well; others said the experience made them feel let down and, in some cases, angry that they were expected to absorb new ways of doing things that did not appear to have been designed with patients in mind.

Strained relations

The impact of these changes has strained doctor-patient relations. We heard both warm praise and real concern from citizens about the way practices were managing their services in 2022, with several interviewed blaming politics, austerity and social changes for the mismatch between demand and supply of GPs.

One said he was “pleasantly surprised and grateful” that anyone at the practice responded to his request early in the pandemic. Another was visibly upset by the process introduced over the same period at a practice in the same area of Wales:

In interviews with practices we heard how, from their perspective, they are working extremely hard to manage during challenging times and with limited resources. Some practice staff hope patients will cooperate, sometimes voicing frustration that not everybody understands what is happening backstage.

Emotional and practical support

It is also clear from citizens and some GPs we spoke to that many doctors have consciously adapted their language and processes to provide emotional, therapeutic and practical support where they have noticed someone in need. Our research emphasised how important it is to use language and processes citizens understand and to provide emotional and therapeutic, as well as clinical, support.

We heard many times that some digital tools were not meeting various user needs, including those of basic efficiency and appropriate options for certain types of requests.

One online consultation tool proved particularly onerous, asking “the same question five times”. It also did not provide routes for standard tasks such as booking follow-up appointments, only allowing ‘yes/no’ options for answers at times where nuance would have been helpful.