Agenda item

The chair introduced the item is by explaining this session will be hearing evidence from people experiencing  mental ill - health  to contribute to the review into Access to Medical Appointments.

Vicky and Angela Fernandes, SlaM Advisory group members, were welcomed to the meeting to speak about their experiences of accessing GP services. 

Gosia Kaczmarczyk, Community Engagement Officer, Healthwatch Southwark / Community Southwark , who attended to support Vicky and Angela , was invited to introduce the session by summarising the report on page 7 & 8 of the agenda. 

She highlighted the following points:

•  Frequently mental health patients are experience long waits to see their doctor in person,

•  There has been a push to video and phone appointments, which can lead to diagnostic mistakes,

•  It is difficult for people experiencing mental ill health to get a referral and then if their doctor refers people it often requires persistence to be actually seen by a specialist.

Angela then gave evidence and made the following points:

·  Her GP surgery does not provide medication in time, so she uses the pharmacy, who do provide a good service.

·  During the pandemic, she was unable to see her doctor, and instead received a virtual consultation where she was offered antibiotics, but that was not adequate and she ended up at A & E.

·  Telephone consultations can be good but there is prior need for a face-to-face consultation to establish a relationship.

·  There is a lack of follow up, and this impacts negatively as on well-being and physical health.

·  People are ending up going to Lewisham Hospital - which is not local.

·  She had an experience of 111 booking an emergency appointment at home, which was then cancelled by the doctor who wrongly assumed this to be a repeat issue.

·  A & E can be very busy with a lack of a much needed quiet place for people in mental health crisis.

Vicky then gave evidence and made the following points:

·  Prior to the pandemic she was able to see the same doctor regularly in person, but now she has to see different doctors online and there is a lack of continuity of care.

·  The referrals require persistence to obtain, which is a worrying for people who are too vulnerable to do this.

·  The online applications require high level tech skills and are not user friendly.

·  The pre scheduled appointments at GP surgeries can take 4 weeks or longer, which leads people to end up at the surgery or resorting to telephoning early in the morning to get an urgent appointment , which is a difficult process.

·  Everything is telephone based and it is only possible to book an online call (not a face to face appointment).

·  It feels like the appointment system is at the doctors convenience,  not patients.

·  Some GP surgeries have long and inaccurate voice mail messages.

·  The loss of SELDOC out of hours service, which was decommissioned because of costs,  is a loss of a valued service.

The chair then invited members to comment and ask questions and the following points were made:

·  A member asked if there ought to be a limit to numbers of patients taken on the books if there is insufficient capacity.  In response, participants commented that one surgery lost doctors due to retirement and now use agency staff, which creates problems of continuity and managing follows up. There are many practices like this with underlying issues of staffing.

·  A member commented that in her experience as a carer the online appointments worked well, if preceded by a home face to face visit to establish a relationship with the patient and family.

·  Surgeries have very different set ups and receptionist can vary, and make poor decisions.

·  There is a lot of stress in the system caused by underlying and interlinked issues.

·  The Healthwatch Community Engagement officer said that demographic information is captured in reports, which are published online. The service works with a broad range of people who approach Healthwatch as well as conducting outreach to ensure a diversity of patient voices. Healthwatch  have recently launched specialist surveys for different ethnicities and particular issues: one is being conducted on mental health amongst black communities, the other is looking at access to health care amongst the Latin American community – and it is anticipated that the Latin American survey will reveal language barriers.

·  A member asked if community campaigns to educate patients on the right place to access care would be helpful, and the Healthwatch Community Engagement officer agreed that  this would be beneficial and said a good example is  Healthwatch sign post people to the excellent and reliable Well-being Hub service if they wish to obtain a social care assessment.

·  Better coordination between Primary and Secondary care is important .  People go to hospital as feel safe, which could be avoided through GP surgeries providing better continuity and consistent care.