Workshops session 2 Presentation: Addressing inequalities in access to general practice by Liz Vickerstaff

1. www.england.nhs.uk
GPFV - General Practice Transformation Champions Event
22 March 2018
Liz Vickerstaff, Improving Access to General Practice Team, NHS
England
Improving access for all:
reducing inequalities in
access to general practice
services

2. www.england.nhs.uk 2
 Promoting equality and equity are at the heart of NHS
England’s values, ensuring fairness in the improvements being
made to health outcomes across the country.
 NHS England has a mandate to address the needs of those
who experience barriers in access to general practice services,
improving local and national health outcomes, particularly
addressing poor outcomes and inequalities, by 2020.
 Legal requirements and obligations under the Equality Act 2010,
the Health and Social Care Act 2012, the NHS Constitution and
GPFV
 We want to ensure that the whole population has equal access
to general practice appointments. In particular we need to
ensure that we reduce barriers to access for those harder to
reach or disadvantaged groups within the population. The whole
population should be able to access general practice services in
a place and a time that is most convenient for them.
NHS England’s Values, Mandate Commitment ,
Obligations and Legal Duties “People are
experiencing
poorer outcomes
from poorer
access to services
which in turn could
have an adverse
impact on their life
expectancy”.
The cost of treating illness and disease in
England arising from health inequalities,
has been estimated at £5.5bn (Marmot
report 2010)

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The bigger picture – Right Care

4. www.england.nhs.uk
What are we trying to do?
GP Patient Survey
• Good overall experience of making an
appointment declined from 79.1% in
2011-12 to 72.7% in 2016-17
• 11% (1 in 10) reported not being able
to get appointment
• Likelihood of getting convenient
appointment lower if you are in work
or young
GP Forward View
• Represents a turning point in
investment
• Sets out support package
• Sets out the ambition to strengthen
and redesign general practice,
including delivering extended access
in primary
care
What are the drivers behind this?
What do we want to achieve?
We want to make the most of access to:
• Offer a joined up services to patients
• Effectively connect improved access to the wider system, especially urgent care
• Use funding across general practice to truly transform
• Make the best connects for patients and staff and get the best outcomes we possibly can.
In delivering improved access we want to secure transformation in general practice
“Ensure everyone has easier and more convenient access to GP
services, including appointments at evening and weekends”

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Timing of
appointments
• Commission weekday provision of access to pre-bookable and same day appointments to general practice services
in evenings (after 6.30pm) – to provide an additional 1.5 hours every evening
• Commission weekend provision of access to pre-bookable and same day appointments on both Saturdays and
Sundays to meet local population needs
• Provide robust evidence, based on utilisation rates, for the proposed disposition of services throughout the week.
Capacity
• Commission a minimum additional 30 minutes consultation capacity per 1,000 population per week, rising to
45 minutes per 1000 population
Measurement
• Ensure usage of a nationally commissioned new tool to be introduced during 2017/18 to automatically measure
appointment activity by all participating practices, both in-hours and in extended hours. This will enable
improvements in matching capacity to times of great demand.
Advertising and
ease of access
• Ensure services are advertised to patients, including notification on practice websites, notices in local urgent
care services and publicity into the community , so that it is clear to patients how they can access these
appointments and associated service;
• Ensure ease of access for patients including:
• All practice receptionists able to direct patients to the service and offer appointments to extended hours
service on the same basis as appointments to non-extended hours services
• Patients should be offered a choice of evening or weekend appointments on an equal footing to core hours
appointments.
Digital • Use of digital approaches to support new models of care in general practice
Inequalities
• Issues of inequalities in patients’ experience of accessing general practice identified by local evidence and actions
to resolve in place
Effective access to
wider whole
system services
• Effective connection to other system services enabling patients to receive the right care the right professional
including access from and to other primary care and general practice services such as urgent care.
What do we need to deliver: 7 core requirements

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A range of specific activities to support CCGs in delivering access
and the seven core requirements. Regional teams will support
CCGs directly, with additional national support and products which
include:
 Communications Guide and Resource Pack supports
commissioners and providers to meet the core requirement to
ensure services are advertised to patients,
 Inequalities Resource designed to support the core
requirement to address issues of inequalities ,
 Top Tips for General Practice Providers guidance on key areas
for establishing improved access to general practice services.
 Case studies and innovation showcases: sharing learning
from the GP Access Fund pilot schemes.
 Subject specific webinars on procurement, inequalities and
communications with other topics to follow. Direct peer to
peer support from a named ‘buddy’ to access support as and
when required : 28 buddies are currently part of the network.
 Buddying directory shared with CCGs providing
details of all buddies and their areas of expertise.
 Regional marketplace events bringing together local CCGs
and relevant buddies to provide information and examples of
how they have identified and tackled challenges and
opportunities within their own schemes.
 Online networking forum sign up at:
www.networks.nhs.uk/nhs-networks/improving-access-to-
general-practice-commissioner to connect with the national
team, buddies and other commissioners.
Resources are available at www.england.nhs.uk/gpaccess
What support is being offered nationally?

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 Resource designed for providers and
commissioners of general practice services.
 Designed to support core requirement to address
issues of inequalities in patients’ experience of
accessing general practice identified by local
evidence and put actions to resolve in place.
 Interactive pdf format with “rollover” and “drill
down” capability for ease of navigation.
 Supports understanding of any groups locally
who are experiencing barriers in access.
 Includes case studies, top tips, ideas and
innovations and a wide range of reference
sources.
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Reducing inequalities in access to general practice
services

9. I am your
LGBT Patient
...How YOU can improve YOUR
service

10. The goals of this session
are to:
• Understand some of the barriers faced by the LGBT
community when accessing General Practice
• Be aware of how you can support LGBT patients in your
role, and...
• How you can get the support you need to do this!

12. SOMETIMES WE RECEIVE A FANTASTIC SERVICE...
“My regular GP will ask if I would like her to ring my wife when I am ill (I have life threatening
illnesses). She treats us like any other married couple”
“I am out to my GP and hospital services. I have been treated with the greatest of respect. My
partner is always acknowledged and I have not experienced any discrimination”
“My GP has not made an 'issue' of my sexuality once since she was made aware of it”
“I came out as Bi to my GP after ten years and she was really supportive and understanding. I
said that I felt that I was wrong in every way and she said that sexuality is not an issue.”
“My previous GP was brilliant about me being a gay trans man, really supportive. Some
healthcare professionals have interrogated how I can be both gay and trans, which is always
awkward, but she immediately understood that gender and sexual orientation are different and I
always felt that my partner was welcome in consultations…”
“I visited my GP last week and there were LGBT posters on reception and on the notice boards.
This made it much easier to discuss my feelings and health needs with my GP, she was also
very open and supportive about my sexuality.”

13. OTHER TIMES...
“When I went to my previous GP regarding my IBS they informed me that if I gave up being gay
and married a nice girl I would be completely cured of my illness”
“Often GPs or Doctors who do not know me assume I am heterosexual and married. The last
serious event was in a women’s health clinic when the consultant asked what my husband
thought of the idea of another operation. I had already filled in their monitoring form and said I
was married to a female”
“My GP is in a rural practice and staff assume I'm straight e.g: when discussing sex, or at the
very least routinely using heteronormative language. I bet they think there are no queers here,
but they are very wrong. They need to understand that all these low level issues actually really
matter.”
“When I saw my GP to address some health problems, I explained I'd had same sex partners,
and he had a coughing fit so bad I offered to get him a glass of water.”
“I was told I was greedy by a GP for being Bi even though I've been with my partner for five and
a half years and we are due to get married.”
“I have had GPs stare at me in silence when I said my partner was a woman. One GP told me
she didn't know what STIs I could get as a women who was having sex with women.”

14. (Public Sector Equality Duty)
• Foster good relations between people who share a protected
characteristic and those who do not.
• Having due regard for advancing equality involves:
• Removing or minimising disadvantages suffered by people due
to their protected characteristics.
• Taking steps to meet the needs of people from protected groups
where these are different from the needs of other people.

16. 'Let’s face facts: research shows that LGBT+
people have unique health needs and currently
experience huge health inequalities - both in
terms of the services available to them, and the
attitudes they face from professionals.
If we are going to tackle these issues, we firstly
need to know who our patients are and what they
need. That means collecting useful information so
that we can offer the right people the right care.
If you don’t want to divulge that information, you
don’t have to, but it could go a long way to helping
someone.
Yes, this is personal information and we must
make sure we use it carefully and properly. But it’s
not about prying into people’s sex lives or making
anyone feel uncomfortable.
It’s about making sure that everyone gets the
good standard of care they deserve, regardless of
who they are - and that is our job as medical
professionals'.
Dr. Ranj Singh

19. Good Practice Guide to
Monitoring Sexual
Orientation
• Offers advice and practical tips for your
organisation on how to best monitor
sexual orientation.
• It makes use of case studies and
examples from the work of the NHS and
wider public sector research to offer a
step-by-step guide to the process of
sexual orientation monitoring, illustrated
with best practice examples and real-life
case studies.

20. Posters like this
>>>>>>>>>>>>>
Can be displayed in reception, in
consultation rooms, even in rest rooms.
They let your LGBT patients know that
they are welcome, safe and that you will
understand if they need to discuss issues
relating to their identity.
They demonstrate that you are confident
and comfortable at addressing their
concerns and are aware that they may
wish to access other organisations for
support .

21. Useful resources –Trans people's
health
TRANS GUIDE 1: Helpful guide to changing your name and getting
a gender recognition certificate.
TRANS GUIDE 2: Handy guide summarising support available for
GPs and trans people's rights at the GP.
Both guides available to download from link below:
http://lgbt.foundation/who-we-help/trans-people/resources-for-trans-
people/lgbt-foundation-resources-for-trans-people
PHE SCREENING RESOURCE: for people who are trans or non-
binary (any gender that is not exclusively male or female) as part of
its commitment to make screening accessible and inclusive for all
eligible populations.https://www.gov.uk/government/publications/nhs-
population-screening-information-for-transgender-people

22. What You Can Do Next...
Thank You!
• e-mail: pip@lgbt.foundation
• web:http://lgbt.foundation/
• Twitter: @LGBTfdn
#PrideinPractice
• Work with your local
LGBT organisations, find
out what services they
provide and promote them.
• Implement NHS
Information Standard Sexu
al Orientation Monitoring.
• Include Trans Status
Monitoring.
• Keep in touch!

23. www.england.nhs.uk
 Evolving process - not a form
 More effective and efficient if started early
(avoid the post-mortem approach!)
 Need commitment and engagement by senior
decision makers
 Engagement with services users is important
 Potential impacts and actions should evolve
 Holistic approach across all core requirements
 Consider positive and negative impacts across the patient pathway for
vulnerable groups and those belonging to protected characteristics groups
 Further webinars and animated resources:
 Patient pathway approach
 Right Care
 Conducting EIA/HIA
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Addressing inequalities – EIA/HIA

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 Commissioners need to produce an
equality impact assessment to determine
where action is needed and demonstrate
an awareness of any inequalities in access
which affect their local populations and
have action plans in place to address these
including implementing specific services
e.g. translation services, to address the
needs of patients.
 All patients should have equal access to
general practice services and should be
able to book an appointment to see a GP,
nurse or other health professional at a
time and in a way that is most convenient
for them. No population groups e.g. those
in work, the homeless or travelling
community should be disadvantaged.
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Addressing inequalities - Key Messages

25. www.england.nhs.uk
Email: england.gpaccess@nhs.net
www.england.nhs.uk/gpaccess