Enter and view: GP Hub and associated services

This Healthwatch Havering report reviews the borough’s GP Hub service and associated GP practices approximately one year after the introduction of extended-hours GP Hubs in Havering. The review was conducted between May and July 2016 through Enter and View visits to the two GP Hubs (Rosewood and North Street), as well as several associated practices and services.

The report explains that the GP Hub model was developed to improve access to primary care outside normal surgery hours and reduce pressure on A&E services. The Havering Hubs operated from North Street Medical Centre in Romford and Rosewood Medical Centre in Hornchurch, providing appointments during evenings and weekends. During an eleven-week period reviewed by Healthwatch, nearly 3,900 appointments were available, with most booked directly by patients. 

Overall, Healthwatch concluded that the Hub service was functioning effectively and generally meeting patient demand, with patients reporting high levels of satisfaction once they had accessed the service. Appointments were usually available on the same day, waiting times within the Hubs were short, and patients valued being able to see a GP outside normal working hours. 

A major finding was that public awareness of the Hub service remained low. Many patients interviewed during the review had never heard of the Hubs, did not know how to access them, or were unaware that one operated from their own GP practice. Healthwatch concluded that communication about the service was insufficient and that more active promotion was needed by GP practices and NHS organisations.

The report found that many patients continued to rely on A&E departments and traditional GP services because they were more familiar, even when other urgent care options such as NHS 111, Urgent Care Centres or GP Hubs may have been more appropriate. Healthwatch suggested that confusion about urgent and emergency care pathways was widespread among local residents. 

The visits highlighted several examples of good practice within the Hub service. At both Hub sites, reception staff were described as friendly and supportive, practices were generally clean and accessible, and patients were usually seen on time. Patients particularly valued the convenience of evening and weekend appointments and the ability to continue working during the day before attending appointments later in the evening.

However, patients reported ongoing difficulties with telephone access, both at some GP practices and when contacting appointment services. Some described having to repeatedly redial before reaching a receptionist or call centre. Several practices also received complaints about long waits on telephones and difficulties obtaining appointments. 

Healthwatch identified recurring concerns about privacy at reception desks across a number of practices. Patients were often required to discuss personal matters in public waiting areas, and reception layouts sometimes made confidential conversations difficult. The report suggested practices should consider ways to improve privacy and patient dignity. 

The review also highlighted practical issues affecting patient experience, including inadequate signage for Hub services, accessibility problems in some buildings, limited disabled parking, outdated websites, poor visibility of information, broken or ineffective electronic information screens, and concerns that some patients could not easily hear their names being called in waiting areas.

Across the practices visited, Healthwatch observed strong examples of patient-centred care, including support for carers, annual health checks for people with learning disabilities, online booking systems, active Patient Participation Groups in some locations, and growing use of text messaging and electronic communication.

The report concluded that the GP Hub model had been successful and well received by patients, but warned that increasing awareness would likely generate additional demand. Healthwatch therefore recommended that capacity planning accompany any expansion of promotion. The report also recommended better communication about Hub services, improvements to reception privacy, enhanced waiting-room communication systems, clearer signage, improved websites, greater support for patient participation, and continued development of integrated primary care services.