Communicating changes to primary care to the public has been an “abysmal failure”, MSPs have been told, and the whole programme has thrust GP receptionists into a role of “gatekeeper” – sometimes without the proper resources or training to do the job.

The Chair of the Patient Participation Group at one of Scotland’s largest GP surgeries, Margaret McKay, told Holyrood’s health committee digital exclusion is her biggest concern – with some people unable to even access repeat prescriptions.

“Some of these changes are increasing health inequalities.

“These changes have to be known to all patients – not just savvy patients with time to go through the different pathways”

In its response to the committee’s consultation on the issue, the professional organisation for GPs, RSCPG, said alternative pathways can be seen as blockers or delayers of care and called for changes to be backed by evidence to ‘ensure their development does not exacerbate existing health inequalities’.

The changes come as part of the controversial 2018 GP contract, which seeks to minimise GP workload by recruiting a wider range of professionals to practice teams and transferring some services to health boards.

Alternative pathways to primary care include people being directed to other types of support through “social prescribing”, using telephone helplines or websites, or seeing a different health practitioner either within a GP practice or local community, such as a nurse or pharmacist.

Healthcare Improvement Scotland said in its consultation response that increased adoption of alternative pathways depends on a number of factors, including local availability and awareness of services, as well as patient confidence and trust in their delivery.

Ms McKay who works in patient outreach at Musselburgh’s Riverside Medical Practice, told the committee:

“Getting over to the public that general practice is changing, why it needs to change and what is going to be put in place to ensure healthcare needs are fully taken account for - I’d say there’s actually been an abysmal failure in that.

“There really needed to be a communication plan that was at national, local – by local I mean either health board or local authority area – and then much more at the practice level.

“That messaging has taken place in some places but it’s been fragmented, it’s not been coherent and it’s certainly not been integrated.”

The committee heard GP receptionists, who play a role in guiding patients to the most appropriate care, are now seen by the public as “gatekeepers” of healthcare rather than “facilitators” – but Hannah Tweed, a senior policy officer from the Alliance, said there is often not the right support in place:

“We need people to be supported and enabled to effectively signpost and link people into their communities. And there needs to be resources for that.”

The Associate Medical Director at NHS Borders this week released a plea to the public to treat reception staff with dignity and respect, following concerns the public does not understand their role.

Dr Tim Allen said: “When you call your local GP practice your care begins the moment a member of our highly trained reception team answers your call.

“The conversations you have with practice receptionists are confidential and are structured in a way to help you get the right care for your needs from the right expert.

“As part of their role, reception staff are empowered to ask you questions in order to assist you. They are there to help so please treat them with dignity and respect.”

One study in a review of opportunities for social prescribing in Scotland found as many as three quarters of GPs had prescribed antidepressants when they would rather offer an alternative treatment.

The author of the Support in Mind Scotland report told conference attendees last year that awareness of options, even where they were available, is lacking among both the public and those working in primary health.

But the health committee this week heard the public are often not satisfied with a referral to non-medical services, such as community hubs, befrienders services or sports groups.

Val Costello, Patient Adviser, Citizens Advice Scotland Patient Advice and Support Service; said:

“I completely understand when someone goes to the GP practice and they are offered an alternative, that is not seen as what a patient would want as they’re looking for a tablet that’s going to cure everything. And that’s not always the case.

“And I think that does need a lot of education, knowledge, public awareness for alternative methods now. Again, it comes down to health literacy.

“Targeted communication is key. “

A target to recruit an additional 250 community link workers (CLWs), who work alongside GPs to direct patients to non-medical support, was missed by the Scottish government last year.

Ms Tweed from the ALLIANCE, which currently employs around 59 CLWs across Glasgow and West Dunbartonshire, told MSPs that, with people who have bult up established links, the services can offer an alternative route – but more must be done to embed their role in primary care:

“I think there’s also something in expanding the provision of CLWs as broadly as possible to really make this not an alternative route but the norm. To say: “This is the way Scotland delivers a range of care” and to break that barrier that puts so much pressure on the primary care service.

“Culture change is needed to embed this especially where it’s new. This isn’t just people being palmed off”

 

Read more: MSPs to probe alternatives to relying on GPs; GPs ‘unaware’ of social prescribing options; Government misses GP link worker target

 

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