Just who is this an improvement for? 

Why designing ‘better services’ needs user input.

A recent Kings fund blog talks about pressures on GP services, specifically the problem of providing both rapid access and continuity of care reminded me that the need to treat patients as individuals is important at a system level. Here are some of my personal experiences and opinions of accessing NHS services.

Personally I have had so many changes in staff at my GP’s that there is little hope of continuity of care, and for most of the time it has not mattered in the least to me, but for other people this will be a different story. We are all different with different needs and priorities: while my elderly neighbour with a complex medical history is happy to fit around her GP’s availability, I would rather that appointments fit around my busy life. I have a feeling that trying to provide services to meet pre-conceived ideas of what patients want just leads to causing problems elsewhere. In the days when I had a long commute to work I wished that my health records could be shared or held by me, and I could visit a GP near work sometimes and near home at other times, I was not at all bothered by who I saw.

 One of the recent changes at my GP’s is to have a call back from a member of staff if you have an urgent problem as not all patients can be given appointments on the day. This sounds great, but it seems to assume that you will be able to take a phone call at any time. My experience was that firstly despite me requesting that my mobile number was used the home phone was called and I missed it and spent all day in a cycle of missing and trying to return calls. I would have much preferred to go and sit in the waiting room for a few hours actually.

This made me wonder about some of the reasoning behind the changes – what are the assumptions at work here? When coming up with the new ways of working is there an assumption that if you need an appointment with GP or nurse that you won’t have responsibilities like dropping kids off at school, having to go out and buy things, another appointment to go to, or even work and leisure activities perhaps? I understand that services cannot take into account every individual situation, but without user involvement there is a risk that despite best intentions new ways of working eg telephone triage will make it even harder for some patients.

https://www.kingsfund.org.uk/blog/2017/02/how-can-gps-provide-rapid-access-alongside-long-term-continuity-care?utm_source=twitter&utm_medium=social&utm_term=thekingsfund

https://arms.evidence.nhs.uk/resources/qipp/915463/attachment