GP Access in Warrington: Exploring Ways to Improve Access and Share Best Practice

This report summarised findings from 14 Enter and View visits to GP surgeries across Warrington conducted between September 2016 and April 2017. Healthwatch Warrington undertook the project because difficulties accessing GP services had consistently emerged in public feedback. The study combined observations from surgery visits, feedback from Practice Managers, and 146 patient survey responses to identify barriers to access, examples of good practice and opportunities for improvement.

Overall, the report found that most patients were satisfied with their GP services and valued the quality of care provided by surgery staff. Patients frequently praised GPs, nurses and reception staff for their professionalism, compassion and commitment despite increasing workload pressures. Many respondents stated that the care they received was excellent and appreciated the efforts staff made to support patients.

The most significant access issue identified was telephone access. More than 90% of survey respondents relied on telephone booking systems, making this the most common way of securing an appointment. However, many patients reported long waiting times to get through to reception, busy phone lines and difficulties obtaining appointments once contact had been made. Some patients described repeatedly calling their surgery before successfully reaching a receptionist, while others felt that automated telephone messages created additional delays.

Although dissatisfaction with telephone access was common, most patients were broadly satisfied with appointment booking arrangements. Around 68% of respondents reported being satisfied or very satisfied with their surgery's booking system. However, only a minority said they could always obtain appointments at their preferred time, and many wanted greater flexibility through advance booking options. 

Patients placed considerable importance on continuity of care and seeing the same GP whenever possible. While many respondents reported that they could often see their preferred GP, others highlighted difficulties due to appointment availability and staffing constraints. Both patients and Practice Managers agreed that recruiting additional GPs and frontline staff would help improve continuity of care and access to appointments. 

The report found that online booking systems offered opportunities to improve access and reduce pressure on telephone systems. However, patients wanted online services expanded so that they could book appointments with a wider range of clinicians, including nurse practitioners, and access urgent appointments. Some respondents also reported technical difficulties with online systems or were unaware that online booking was available. 

Healthwatch identified a range of environmental and accessibility issues across surgeries. These included problems with signage, cluttered noticeboards, lack of automatic doors, insufficient wheelchair access, poor visibility of information displays, and inadequate facilities for disabled patients in some practices. Concerns were also raised about privacy at reception desks, where confidential conversations could sometimes be overheard.

Many surgeries demonstrated examples of good practice. These included electronic check-in systems, hearing loops, translation services, dementia-friendly design features, text appointment reminders, wheelchair-accessible facilities and proactive Patient Participation Groups (PPGs). The report highlighted the important role of PPGs in helping surgeries communicate with patients, support service improvements and raise awareness of issues such as missed appointments. 

The report also found that Patient Participation Groups varied considerably in visibility and effectiveness. Some were highly active and influential, while others had a limited profile. Healthwatch recommended stronger promotion of PPGs, increased patient involvement and wider recruitment to ensure groups were representative of local communities. 

Practice Managers emphasised the importance of partnership working through Warrington's GP cluster model. Many believed that closer collaboration between practices, investment in primary care and the development of specialist services within community settings could improve access and reduce pressure on hospitals. They also highlighted difficulties recruiting GPs and securing funding for building improvements and accessibility upgrades. 

A recurring concern from both surgeries and Healthwatch was the impact of missed appointments (DNAs). Some practices reported more than 100 missed appointments per month, reducing appointment availability for other patients. Managers supported greater use of text reminders and awareness campaigns to encourage patients to cancel appointments they no longer needed.

The report concluded that Warrington's GP surgeries were providing good-quality care under considerable pressure, but that improvements were needed in telephone access, online booking systems, building accessibility, patient information, privacy arrangements and workforce capacity. Healthwatch recommended greater investment in staffing, stronger support for Patient Participation Groups, better promotion of alternative healthcare services such as pharmacies, improved accessible information, and continued sharing of good practice across GP practices and healthcare organisations.