GP Services in Wales: The Perspective of Older People
Older people’s experiences of accessing and using GP services in Wales
Overall, it is clear that GP services and the wider primary care offer is highly valued by older people across Wales.
However, while many older people reported positive experiences of using GP services, reflecting the good practice and innovation that exists in some areas, there is an unacceptable level of variation in people’s access to and experiences of using these services. Furthermore, a significant number of older people felt that their access to GP services was not sufficient, and that their experience of using these services was not positive.
In analysing the findings of this work, a number of themes also emerged from which I have drawn the key findings set out below.
For too many older people, making an appointment is challenging, inflexible and unresponsive to individual needs and circumstances. This is particularly relevant for older people living with sensory loss, dementia or a cognitive impairment, as well as for carers. There is a risk that such challenges could push some older people into accessing unscheduled care options instead of more appropriate primary care services.
Continuity of care is central to the confidence and trust that is held by older people in GP services, as are the relationships that can develop between an individual and a professional. The awareness that older people have of the current workforce and other pressures within GP services and primary care is a cause for concern for older people, particularly with regard to the implications this may have for continuity of care.
While new build primary care centres are providing improved physical accessibility to GP services, the accessibility of many existing buildings continues to act as a barrier to access for some older people, with issues around the use of hearing loops, appropriate seating, use of audio-visual announcements and the functioning of automatic doors.
The importance of personal interactions within a GP service, the degree to which older people feel listened to and understood and the degree to which they have a say in decision making should not be underestimated. For a number of older people, their GP service is not sufficiently aware of, or responsive to, their individual communication needs, particularly those living with a sensory loss or dementia or cognitive impairment.
The practice of asking individuals to describe the reason for an appointment (to ensure they’re seen by an appropriate professional) is currently not adequately explained to, nor widely understood by, older people. This causes unnecessary distress and could put the privacy and dignity of older people at risk.
There is an understanding, whether perceived or explicit, that older people can only raise one issue within a ten-minute appointment. This could jeopardise their ability to have a say in decision making as individuals feel rushed and that the professional is not engaged, something that reduces their confidence. This is a particular issue for older people who may need more time, such as those living with a sensory loss, dementia or cognitive impairment, or a complex condition.
The ability to access GP services through the Welsh language can impact on the quality of that service and the dignity and respect experienced by older people. Some older people who wish to access GP services in the Welsh language are experiencing delays due to the availability of health professionals who speak Welsh.
Too many older people find it difficult to provide feedback, or raise a concern or complaint, about their GP service, and are fearful of the perceived implications of doing so on their future access and treatment.
Alternatives to traditional GP services
Older people who have accessed alternatives to traditional GP services reported positively on their experiences, although these services have not been consistently developed across Wales. Many older people are simply not aware of the existence of appropriate alternatives to seeing a GP and therefore do not have the necessary support to access these.