Choosing Your Healthcare

Healthwatch Bolton asked people for their experiences of using their GP, A & E, NHS 111, Pharmacies, Urgent Treatment Centres and the Urgent Dental Care Service. They wanted to find out what people knew about these services and how to use them. They also wanted to understand the behaviours of people who attend A & E, if their health condition is not considered to be life threatening.  They undertook a survey and focus groups, reaching 443 people in total.

While there are many positive experiences with GP services, particularly in terms of compassionate care and prescription fulfilment, many patients face significant challenges. Accessing appointments, whether by phone or digitally, is difficult and frustrating for many people. Most respondents prefer to access their GP practice by telephone and many secure an appointment either on the same day or within a few days. Patients often lack continuity of care, have difficulty seeing the same GP or health professional, and feel rushed through appointments, and encounter difficulties with staff communication, especially at the reception desk. 

Vulnerable groups, including older people and those with complex health needs, face additional obstacles, including the lack of follow-up care and difficulty navigating the appointment systems. Some participants mentioned slow or inadequate referral processes, leading to escalations like visits to A & E. Some reported difficulties securing same day appointments with GP practices, leading to attendance at A & E.

People attend A & E mainly when they are directed to by a healthcare professional, when they believe their condition is urgent or life-threatening, or when they have no other viable options for care. Some people indicated that they were aware that their issue was not appropriate for attending A & E, however they felt they had no other option available to them, such as a same day appointment at their GP. 

Other factors that influence decisions to attend A & E include long wait times, the complexity of the process, and concerns about service quality, particularly for mental health issues. There are also instances of people feeling they have been sent to A & E because their GP does not want to deal with them. A very small minority did say that they attended A & E due to the proximity of where they lived, and if they could not secure an appointment with their GP. 

The reasons for attending A & E visits ranged from traumatic injuries (falls, fractures) to medical emergencies (chest pain, respiratory distress, seizures, and infections) and chronic condition management (e.g., high blood pressure, pancreatitis). Many visits were directed by medical professionals like GPs or NHS 111. There was also a mention of A & E being a ‘trusted’ place to attend to get guaranteed treatment. From feedback from people in attendance at A & E, one person felt that their GP had sent them there as the GP did not want to be ‘bothered’ to treat them, but once in A & E it was made clear to them that they were in the right place. Another attendee was the parent of a disabled child and felt that A & E was becoming a ‘default’ option for their care.

Before attending A & E, people used various healthcare services, including calling an ambulance (for conditions like sepsis or injuries), with the majority contacting their GP or NHS 111 (especially on weekends), visiting walk-in centres, seeking help from St John Ambulance, or seeing a chiropractor. Some also used out-ofhours GP services like BARDOC1, and a few contacted other providers such as Achieve2 or dialysis departments. In some cases, individuals were unsure of the steps they took but typically tried these options before going to A & E.

While many people who used the Urgent Treatment Centre (UTC) at Bolton Hospital were satisfied with their care, there is low awareness of the service among the public. Long wait times, occasional confusion about the service, and varying treatment experiences were common. However, those who were directed to the UTC from A & E or NHS 111 generally had positive outcomes once seen and were happy with the care and service provided. More information and clearer signage about the UTC service could improve its visibility and user experience.

NHS 111 users reported a mix of experiences, with some facing delays with getting call backs, inconsistent service, and miscommunication, while others appreciated quick escalation, out-of-hours advice, and helpful guidance for both urgent and non-urgent issues. There was mixed awareness regarding knowledge of NHS 111’s ability to book appointments with health professionals, indicating that some people did not fully understand the range of services NHS 111 could offer beyond advice and referrals.

While basic pharmacy services like advice, vaccinations, and some health checks were well-known and widely used, there is a gap in awareness regarding the full range of pharmacy services available, particularly for minor ailments, medication prescriptions (without the need to see a GP), and the Pharmacy First initiative3. Many individuals either had infrequent visits to pharmacies for health advice or hadn’t used them for such purposes in many years. Those who did visit typically sought advice for specific issues or routine prescription services. People also reported that they felt uncomfortable to ask a pharmacist for health advice because of workload issues – or the pharmacy being very busy.

While the Urgent Dental Care Service4 is generally known to many respondents, awareness gaps still exist, especially regarding how to access it. Experiences with the service are mixed: some find it helpful and accessible, while others encounter challenges with availability, accessibility including transport, and continuity of care. Awareness is important for vulnerable groups and those who are new to the area. There is still a gap in the provision of NHS dentistry with some respondents saying they do not have an NHS dentist. Some have had to attend A & E to get dental treatment.

People are calling for quicker access to healthcare and better access to GPs. People want reduced waiting times for appointments, more staff and resources and better continuity of care, with improved infrastructure and facilities and less confusion. There's also a strong demand for more accessible services, better communication, more compassionate care, and enhanced support for vulnerable groups such as older people, disabled, and those with mental health needs.