General Practice Access Short Life Working Group: access principles

1. Preface

Currently, General Practice is under significant pressure. Like many parts of the health and social care system, it is experiencing increased demand and higher public expectations post-pandemic alongside continuing challenges recruiting and retaining General Practitioners (GPs) and other members of the practice team (clinical and administrative). These challenges are making it difficult for the public, in some parts of Scotland, to access the care they need from General Practice when they need it.

Even before the pandemic, General Practice was having to change the way it provided services to meet the needs of the public with changes in technology, the expansion of the clinical and administrative teams, and the introduction of new systems and processes. Lack of awareness and public understanding about these changes, how the system works, who could you be seen by and where people can access care have all created a complicated, confusing, and challenging situation. These issues alongside a more complex health and social care landscape have compounded the difficulty people have understanding how best to access the care they need, when they need it.

Despite these issues, General Practices across Scotland continue to strive to deliver high quality care. We recognise that General Practice in Scotland is a core, highly valued part of the integrated primary care landscape, free at point of delivery, and whilst we recognise the challenges it faces. We should also be extremely proud of what General Practice delivers every day to the people of Scotland and their resilience to manage the increase in activity in recent years.

We equally must accept that in some areas General Practice is struggling to deliver what we would all aspire it to deliver under current pressures. We recognise that the capacity of General Practice teams will always be the fundamental constraint on how well practices are able to meet the needs of their patients. The following Access Principles have been developed to help practices consider how to best meet the needs of their communities in differing and sometimes difficult circumstances.

At the heart of General Practice is the desire to meet the needs of their patients in the best way that General Practitioners and practice teams possibly can. However, General Practice’s reputation for doing this can sometimes be threatened by patients’ expectations and widespread criticism that it is too hard to access appointments when people wish them or need them. This criticism compounds the pressures noted above and has a direct effect on the General Practice team’s morale and the retention of staff.

For many people, online access to services, including their General Practice, is a normal part of their everyday activities. We are moving to an increasingly digital world with digital technology empowering some people to access the care they need more easily. Developments such as Near Me video consultations and NHS Inform can be useful for some.

In addition there has been an increase in what many General Practices offer including on their practice websites, online appointment booking and repeat prescription ordering, Digital Asynchronous Consulting Systems such as eConsult®, AskMyGP® or online reviews on MedLink® to name a few. These have become the norm in many areas, allowing patients to have more choice around how and when they access care.

Following a request from the Cabinet Secretary for Health and Social Care we have collaborated with key stakeholders to develop high level core Access Principles to support and enhance people’s experience of accessing ‘The Right Care, Right Time, Right Place’.

In his letter to General Practices in November 2022 the then Cabinet Secretary said:

“I have been clear in the past that any suggestion that GPs have not been seeing people face-to-face because they did not want to was false and dangerous. I have absolutely rejected that suggestion and condemned the abuse that has been directed towards General Practice staff. I have also been clear that introducing any arbitrary targets for face-to-face appointments would not be helpful because every practices’ patients have different needs and the best mix of appointment types to the right member of the team is something that requires the judgement of professionals who have a long term responsibility for their patients.

That is still my position.

However, I continue to receive regular correspondence and feedback from elected members with concerns being raised about access to General Practice. The perception that General Practices are closed, do not provide face to face appointments and are unwilling to provide pre-bookable appointments for patients is damaging the reputation of General Practice and I am keen to work with the sector to demonstrate the good work we know is happening in General Practice and work collaboratively on where improvement still needs to be made.”

We hope that working with the Access Principles will give General Practices a way to clearly demonstrate that they provide the best care and service for their community that they possibly can. We also hope that these Principles will help the public to understand what, how and why their General Practice is delivering care in the way that they are. An Easy Read version of the principles will be available in due course.

We wish to be clear that these Access Principles are not standards that General Practice will be measured or judged against in any way. Rather these are Principles that we hope all General Practices will aspire and strive to deliver - indeed many already deliver them. Ultimately, we hope these principles will be utilised across the wider healthcare system with General Practice as the leading example and that they will be utilised as a basis for improvement.

These Access Principles have been developed collaboratively with key stakeholders from General Practice, Health Boards and Health and Social Care Partnerships (HSCPs), professional bodies (RCGP and SGPC(BMA) and most importantly, the public. The work of the Healthcare Improvement Scotland (HIS) Community Engagement Team in facilitating focus groups and their Citizens’ Panel has been extremely important and helpful in developing the principles.

It is important to note that from the HIS Community Engagement Report^[1] the public described their ideal General Practice as –

“accessible, equitable, flexible, inclusive, responsive, approachable, welcoming and non-judgemental.”

We believe this is what everyone working in and with General Practice and the wider healthcare system would hope for and aspire to.

When asked, the public said that the most important things to them regarding access to General Practice were:

1. Being able to access appropriate care in a reasonable time (45%)

2. Followed by a reliable appointment system (31%)

3. And appointments with appropriate healthcare practitioners (26%)

We would like to strongly encourage all General Practices across Scotland to read this paper and consider the Access Principles with an open mind and consider the principles in the most appropriate way for them to support people to access the care they need when they need it.

We would ask the public to support their General Practice and treat the practice team with dignity and respect. Violence and aggression (both verbal and physical) towards any member of the practice team is not acceptable and could have severe consequences. We would encourage General Practices to welcome feedback from people (both informally and formally) and use that in a positive way to learn, develop and improve their services.

We would like to thank everyone who has been involved and given their time, knowledge, and experience to help shape the Principles.

Finally, we would like to thank our Scottish Government colleagues who have supported us through this work, Michael Taylor, Nicola Rae, and the rest of the Primary Care Directorate and to our colleagues in the HIS Community Engagement Team for their amazing work capturing the public’s voice.

Thank you.

Dr Scott Jamieson - GP - Kirriemuir Medical Practice NHS Tayside

Fiona Duff - Senior Advisor - Primary Care Directorate, Scottish Government