GP Access and Out of Hours Provision Survey: review of actions

This report reviewed progress made by NHS Halton Clinical Commissioning Group (CCG) against recommendations arising from Healthwatch Halton's 2014 survey on GP access and out-of-hours services. The original survey gathered feedback from 491 residents and highlighted significant concerns about access to GP appointments and primary care services. The review assessed progress approximately two years after the CCG introduced an action plan in response to 17 recommendations. 

Overall, Healthwatch concluded that progress had been made in several areas and that the CCG had demonstrated a commitment to improving services. However, implementation had been uneven and some initiatives had been more successful than others. Healthwatch noted that greater communication on progress throughout the implementation period would have been helpful. 

A major theme throughout the review was the role of Patient Participation Groups (PPGs). The report found that PPGs varied considerably in effectiveness across Halton's 17 GP practices and that the borough-wide PPG Plus network had declined, with representation from fewer than half of practices. Healthwatch felt that too much responsibility for delivering improvements had been assigned to PPGs without sufficient support and recommended that both local PPGs and PPG Plus be revitalised to play a more effective role in service improvement and sharing best practice.

The review recognised improvements in public communication about healthcare services, including campaigns such as "Examine Your Options" and the distribution of healthcare information to households across Halton. However, Healthwatch felt that communication remained too dependent on periodic campaigns and recommended developing more continuous methods of keeping residents informed, including easier-to-use digital technologies and alternative non-digital options for people who are unable or unwilling to use online services. 

The report highlighted limited progress in understanding and evaluating telephone triage systems. Although some practices were using triage models, there was little evidence of a coordinated evaluation of their effectiveness or patient satisfaction. Healthwatch recommended that the CCG and practices undertake a review to provide better guidance on the value and impact of triage systems for both patients and practices.

In relation to opening hours and appointment access, the review noted positive developments through the GP Extra scheme, which had introduced seven-day GP access in Widnes and was being evaluated for wider rollout. However, Healthwatch continued to believe that stronger patient engagement through PPGs was needed to ensure services reflected local needs and preferences. The report also suggested more prominent advertising of practice opening hours through pharmacies and urgent care centres. 

The review found that work on sharing patient records between healthcare providers had been delayed but remained on track. Progress was being made towards allowing patient records to be shared between GP practices, urgent care centres and community services to improve continuity and coordination of care.

Feedback regarding urgent care centres was positive. Healthwatch concluded that the urgent care centres in Halton had been successful, were well used by residents and had helped reduce pressure on local hospital accident and emergency departments. The organisation committed to continuing to collect patient feedback from these services through its outreach work.

The report also considered the handling of complaints. It found little evidence that Patient Participation Groups had been involved in developing or simplifying complaints procedures. While complaints processes followed national guidance and information was available through practices, Healthwatch recommended greater consistency in non-clinical staff training across practices and further work to make complaints procedures easier for patients to understand and navigate. 

Healthwatch made seven recommendations overall, focusing on strengthening Patient Participation Groups, improving communication methods, evaluating triage systems, increasing awareness of service availability, continuing to monitor urgent care centres, standardising non-clinical staff training and simplifying complaints procedures. [

In its formal response, NHS Halton CCG accepted the importance of the recommendations and outlined ongoing work to improve access. This included supporting PPG development, exploring new communication technologies, rolling out different appointment and access models, evaluating GP access schemes, training reception and clerical staff, and encouraging greater patient involvement in service design and complaints processes. The CCG reaffirmed its commitment to working collaboratively with Healthwatch to improve access to primary care services across Halton. [