Response to the Health and Social Care Committee Inquiry into the Future of General Practice in Wales

Key Messages:

• Access to GPs continues to be an issue raised by older people.
• The recommendations from the March 2024 Access to GPs report remain relevant.
• It is essential that non-digital ways to engage with GP practices are retained and operate in a way that does not disadvantage older people and others who are not online.

Introduction

The Older People’s Commissioner for Wales welcomes the opportunity to respond to the Senedd Health and Social Care Committee Inquiry into the future of general practice in Wales.

The previous Commissioner, Heléna Herklots, undertook a significant piece of work on access to GPs in 2023-24 which is relevant to the Committee’s Inquiry.  The current Commissioner, Rhian Bowen-Davies, has continued to progress the work since taking up post in September 2024.

OPCW report on older people’s access to GP practices 

In September 2023, the previous Commissioner was concerned that older people might be struggling to access GP services that meet their needs, and invited older people to share their experiences so she could identify issues that needed to be tackled by GP practices, health boards and the Welsh Government.

Problems with access to GPs, including difficulties with public transport, were also identified in work the previous Commissioner undertook to understand the experiences of Black, Asian and Minority Ethnic older people.

A report, Access to GP Practices:  older people’s experiences, was published in March 2024.  The report found that a significant number of older people throughout Wales were facing difficulties when trying to access GP practices, leaving many individuals suffering in pain, living with deteriorating conditions and feeling worried and anxious.

The report made recommendations to GP practices, health boards, the Welsh Government, the UK Government, planning authorities and local authorities, on:

• building relationships of trust between older people and the wider practice team;

• removing practical barriers to older people’s access and improving communication with older people; supporting older people to attend GP practices and take clinical advice;

• ensuring older people are not digitally excluded from accessing GP practices;

• ensuring sufficient resources are made available to modernise GP practice systems and ensure that older people’s experiences match access and quality standards;

• improving public transport to GP practices, and

• wider infrastructure.

A separate report, Access Denied, on the challenges of digital exclusion, which included access to health services, was published in January 2024.

Guide for older people 

The report also set out the action the Commissioner would take to help improve older people’s access to general practice. One of the findings of the report was that changes to the way services are delivered, and the changing roles of health professionals working with GP practices, had left many older people struggling to find suitable appointments.  GP Practices in Wales: A Guide for Older People was published in July 2024.

Follow-up action 

Also in July 2024, 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.  A progress update report was published before the end of Heléna Herklots’ term as Commissioner in August 2024.

The Commissioner’s office subsequently contributed to the Equalities and Human Rights Committee work on their advice note Digital Services in NHS General Practices: new advice on preventing discrimination on the Public Sector Equality Duty and the importance of maintaining accessible non digital services for certain patients, including those who are disabled and older, and for some ethnic minority patients.

Rhian Bowen-Davies took up post as the current Commissioner in September 2024. The new Commissioner chaired a second constructive roundtable event with key stakeholders in November 2024. Both Commissioners have been grateful for the help of the NHS Wales Executive and health boards in resolving problems, such as digital exclusion, which older individuals are still encountering at GP practice level.

Have Your Say survey 

In December 2024, the Commissioner invited older people to share their experiences and help shape the action she takes as Older People’s Commissioner. The survey closed in February 2025.

The results reflect those of the Access to GP Practices report: older people are still struggling to access the type of appointment they need; waiting times are too long; phone lines and e-consults are not fit for purpose; there is a lack of continuity of care, and some older people feel discriminated against because of their age when attending GP appointments, as though they are not being listened to. Some older people were happy with services, but the majority said that services were not meeting their needs.

Conclusion 

The Commissioner is conscious that the vast majority of patient contacts take place in primary and community care.  She has therefore continued to progress her predecessor’s work to encourage stakeholders to implement the recommendations in the Access to GP Practices report. Access to GPs continues to be an issue raised by older people as evidenced by the consultation to inform the Commissioner’s work programme.

The recommendations from the March 2024 Access to GPs report remain relevant and should be of interest to the Health and Social Care Committee, along with the details of older people’s experiences.

While digital technology offers opportunities to improve GP practice systems, it is essential that non-digital ways to engage with GP practices are retained and operate in a way that does not disadvantage older people and others who are not online.

The Commissioner would be happy to provide oral evidence to the Committee if invited.