Background
As we get older, the healthcare provided by GP practices plays an increasing and crucial role in supporting us to stay healthy, independent and safe, manage long-term conditions and minimise pain. This, in turn, helps to enable us to stay in work, volunteer, support or care for others, take part in family and community life, and age well.
Access to GP practices has been consistently raised as an issue with the Commissioner by older people throughout Wales. In recent years, changes to the way that services are being provided – in particular, the rapid shift towards delivering services online, which was significantly accelerated by the Covid-19 pandemic – risk leaving older people behind, especially those who are digitally excluded.
In 2023, the Commissioner invited older people to share their recent experiences of accessing GP practices in Wales, including making and attending appointments, relationships and interactions with doctors and surgery staff, continuity of care and clinician, and the surgery environment itself, as well as other issues that affect access to GP practices. With crucial support from national and local older people’s organisations, who distributed questionnaires on behalf of the Commissioner, over 900 completed surveys were received in total, from all over Wales, and the Commissioner is grateful to everyone who shared their experiences.
The Commissioner published her report Access to GP Practices in Wales: older people’s experiences in March 2024. The report made a number of recommendations about the action that GP practices, health boards, local authorities and others should take to improve older people’s experiences.
This update provides a snapshot of the progress made so far, including details of the action the Commissioner has taken, as promised in her report.
Action taken by the Commissioner
The Commissioner’s report was published on 21 March 2024 and was disseminated widely to the Welsh Government, NHS Wales, professional and representative bodies and statutory organisations, as well as to third sector organisations, national older people’s organisations, local older people’s groups who had contributed to the report, faith groups and Members of the
Senedd. The report received national coverage on both BBC Radio Wales and Global Radio news bulletins, and the Commissioner’s newsletter included an article highlighting its findings and recommendations, and the report received national coverage in both BBC Radio Wales and Global Radio news bulletins.
The report was received positively by the Cabinet Secretary for Health and Social Services, who said that the report will help to shape the Welsh Government’s work reviewing access standards
during 2024 and considering other aspects of ‘good access’ such as continuity of care.
Following the launch of the report, the Commissioner held meetings with key organisations and stakeholders to share her findings and explore how the issues identified could be tackled.
This included meetings, to date, with the Cabinet Secretary for Culture and Social Justice, the Minister for Social Care, Healthcare Inspectorate Wales, Llais and senior health officials in Welsh Government.
The Commissioner’s team has also highlighted the findings and recommendations at meetings and events with other key stakeholders and organisations, including:
- Health Board Directors of Primary Care
- NHS Wales Executive Strategic Programme for Primary Care
- Royal College of General Practitioners
- British Medical Association
- Welsh NHS Confederation Health and Wellbeing Alliance
- NHS Wales Joint Commissioning Committee Non-Emergency Patient Transport Services
- British Society of Gerodontology
Roundtable event with key organisations
In July, the Commissioner chaired a roundtable event to examine how the required action set out in her recommendations could be taken forward, which was hosted and supported by the
Royal College of General Practitioners.
The event brought together key organisations – including the Welsh Government, the Strategic Programme for Primary Care, the British Medical Association, the Institute of General Practice
Managers, Healthcare Inspectorate Wales, Llais, the Royal College of Nursing, the Association of Directors of Social Services, Digital Health and Care Wales and Age Cymru – with discussion largely focused on four of the Commissioner’s recommendations:
- Removing practical barriers to older people’s access and improving communication with older people.
- Supporting older people to attend GP practices and follow clinical advice.
- Ensuring older people are not digitally excluded from accessing GP practices.
- Building relationships of trust with older people.
Participants recognised that pressures across the public sector are impacting on people’s access to services, and that there was a need to focus on older people in terms of improving communication, tailoring services and ensuring more consistency, as their needs, preferences and expectations are often different to younger generations.
Participants agreed to work together to:
- Focus on ensuring continuity of care in GP services for older patients.
- Improve communications with older people to ensure that they feel valued by their practice, encourage them to come forward for healthcare, increase their understanding of changes in primary care and the roles of other healthcare professionals and build relationships of trust with them.
- Take forward work on preventative care with GP practices and communities.
- Review existing programmes through an equality and diversity lens to get a clearer picture of older people’s perspectives.
- Support older people to use digital devices and resources themselves or through others so that they are not digitally excluded.
- Look within existing reporting systems to identify and disseminate good practice.
- Examine how relationships between social care and primary care can be strengthened, so that people have the support they need to follow clinical advice.
- Discuss transport difficulties with the relevant parts of the Welsh Government.
- Take a systematic approach to reporting how GP practices are communicating change to older people.
- Promote the Commissioner’s information guide on accessing GP practices to older people and colleagues through their networks.
Participants agreed to join the Commissioner’s team for a follow-up event in September to explore the progress being made against the identified action and consider any emerging issues.
Information guide for older people
When the Commissioner published her report, she made a commitment to publish a guide for older people to provide helpful information about GP practices and the services they deliver.
The guide was published in July and includes information on:
- What older people can expect from GP practices
- Older people’s rights
- What to do if older people are experiencing difficulties
The guide also provides details and contact information for organisations that can provide help and support to older people who are finding it difficult to access GP practices, or the services
available, or where people may be concerned that their rights are not being upheld.
The guide is available digitally and in hard copy, and a summary of older people’s rights included in the guide is also being made available in other languages. Accessible versions of the guide are also available in British Sign Language, Audio and Easy Read.
Copies of the guide are being delivered to GP practices, so that they can make older people aware of this helpful resource and are also being distributed throughout Wales via national and
local organisations. The Commissioner’s team will also be publicising the guide to a wide range of other stakeholders and to older people themselves at meetings and events.
Feedback from older people and other key stakeholders – including Welsh Government officials, the Strategic Programme for Primary Care, health boards, professional bodies, DCHW,
the Welsh Language Commissioner’s office, Equality and Human Rights Commission – was invaluable in supporting the development of the guide.
Similarly, the offer of further support from the Welsh Government, the Strategic Programme for Primary Care, NHS Shared Services and health boards to disseminate the guide is invaluable in helping to ensure it reaches older people throughout Wales.
As part of this, the Strategic Programme for Primary Care has also agreed to follow up with health boards and review what use they have been making of the guide over the coming
months.
Responses, feedback and action from key stakeholders and organisations
The responses and feedback received were positive, welcoming the Commissioner’s findings, and highlighting how these are influencing plans and action that will be delivered.
The Commissioner and her team will continue to work with key organisations to press for the uptake of all the recommendations in the report, alongside monitoring the action delivered and
its impact on older people.
Health boards
Responses from health boards provided details of work they are undertaking that will help to address some of the key issues identified in the Commissioner’s report relating to improving
communications with older patients and improving access.
This includes creating information and resources about what to expect from your GP practice and the roles of other healthcare professionals within the practice, as well as customer service
training, modernising GP practice environments and improving complaints monitoring.
Other health boards have indicated that they will be providing more detailed responses which will be reviewed by the Commissioner and her team.
The Commissioner’s Health and Care Lead has also been invited to attend meetings with primary care teams at individual health boards, to discuss the report and how its findings can be used to support improvements at a local level.
Other key organisations
Feedback from other stakeholders in primary care, including the NHS Wales Executive and the BMA, has indicated the Commissioner’s report provides important insights into the lived experiences of older people and will be used to support action in response to her recommendations.
There was recognition that while funding remains a key issue, tackling some issues highlighted by the Commissioner, such as attitudes and behaviours towards older people, can be achieved
without additional resources.
The importance of better communication with older people about changes to the General Medical Services model was also recognised, with a potential approach to supporting practices to inform older people about these changes shared by the British Medical Association.
Several key bodies and stakeholders also made commitments to deliver action in response to the Commissioner’s recommendations at the RCGP roundtable event held on 9 July, as highlighted above.
Welsh Government
As highlighted above, the Cabinet Secretary for Health and Social Care welcomed the Commissioner’s findings and the evidence they provide, which will help to inform Welsh Government policy.
The Commissioner has also discussed her findings and the action required at meetings with other ministers and senior officials.
A summary of the Welsh Government response to the issues raised during these discussions is set out below:
• There needs to be a simpler way of articulating what the primary care model for Wales is and more of an effort to communicate with people in language that is easy to understand about how it works.
• Alongside easier access to all parts of the primary care system, there needs to be consistency in understanding when continuity of care is most important.
• There is a need to create a trusted space for conversations about sensitive issues such as actual levels of concordance with prescribed medicines – the primary care system needs to be more responsive to individual behaviour and preferences.
• There is a need to look at health through a wider lens than just medical intervention, to include issues such as loneliness.
• Developments on the horizon for primary care, including the NHS Wales App, will have implications for the Commissioner’s recommendations and for ensuring equity of access.
Members of the Senedd
The Commissioner’s report prompted a Senedd debate, which took place on 15 May and included contributions from members of all parties, as well as a number of Senedd questions to the Cabinet Secretary for Health and Social Services.
Older people
Older people have welcomed the report at engagement events with them to date and have strongly supported the main themes and recommendations.
Conclusion
The response to the report, health boards’ accounts of action already underway and the positive commitment to improvement by participants at the round table are encouraging signs that older people’s voices are being heard.
It is now essential that policy and service-level commitment translates into better experiences for older people, and that this improvement is evidenced so that all older people in Wales
experience good practice.
The Commissioner and her team will continue to press for the uptake of all the recommendations in the report, monitor delivery of the undertakings made by national level stakeholders, listen to older people’s experiences of accessing GP practices and ensure that the voices of older people are heard.
The Older People’s Commissioner for Wales
The Older People’s Commissioner for Wales is an independent voice and champion for older
people throughout Wales.
The Commissioner is taking action to protect older people’s rights, end ageism and age
discrimination, stop the abuse of older people and enable everyone to age well.
The Commissioner is working for a Wales where older people are valued, rights are
upheld and no-one is left behind.
How to contact the Commissioner:
The Older People’s Commissioner for Wales
Cambrian Buildings
Mount Stuart Square
Cardiff
CF10 5FL
Phone: 03442 640 670
Email: ask@olderpeople.wales
Twitter: @talkolderpeople
Website: www.olderpeople.wales
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Mae’r ddogfen hon ar gael yn Gymraeg // This document is available in Welsh