#HWL19 - Action needed because of unfair process of using 8 day patient removal from GP surgeries

Blog - 4 July 2019

In the spring of 2018, BBC Look North approached Healthwatch Lincolnshire with concerns about a patient that had been removed from a GP Practice under the 8 day removal process, without what they [the patient] felt was acceptable notice.

We discussed with the BBC various reasons why patients may be removed from a GP Practice and was clear that as this appeared to be a ‘one off’ incident it was difficult for Healthwatch Lincolnshire to make any specific comments.

At the time BBC Look North did run the above story, during which they asked any Lincolnshire patients who had experienced similar problems to contact them. By September 2018, we and BBC Look North had been contacted by more patients all experiencing similar problems ie removed within 8 days without, in their view being told exactly why. Whilst patients acknowledged they had queried with the doctor their own diagnosis, treatment and ongoing care (or that of a loved one), they did not believe their behaviour warranted being removed (within 8 days) as a patient from that surgery. In addition, the patients had evidence that in their 8 day removal letter there was no explanation as to why they were being removed.

Healthwatch Lincolnshire was concerned that many of the patients were under extreme stress due to their ongoing health problems, added to this the rurality of our county left them with little choice of an alternative GP practice to register with.

During the period February 2018 – February 2019, 127 patients were removed under the 8 day removal process from GP Surgeries in Lincolnshire.

On behalf of patients we felt this issue needed raising with NHS England, Lincolnshire LMC and Lincolnshire CCGs, so we set up meetings and raised an escalation on this issue. As a result we agreed with the Lincolnshire LMC and NHS England the following actions:

Lincolnshire LMC created a briefing to remind GP practices of the circumstances in which they can and cannot remove patients and the process.
NHS England have reminded Capita about the importance of patient letters being clear and include options/next steps.
Healthwatch Lincolnshire create patient messages and work with PPGs to ensure these messages are shared across Lincolnshire.

Patients need to feel confident to ask questions and raise concerns without redress

“On behalf of patients we were really pleased to work with NHS England and the Lincolnshire LMC as a result of Healthwatch Lincolnshire raising this issue. The support they offered was really positive.”

Sarah Fletcher, CEO, Healthwatch Lincolnshire.

Over the years Healthwatch Lincolnshire has received hundreds of patient experiences concerning the length of time it takes them to get an appointment to see a GP.

Having previously worked on GP appointments in 2014 but from a different angle, then it was the number of missed patient appointments (DNA), we agreed that more work was needed to better understand what the barriers really are getting a GP appointment. Whilst this work originally began in 2017, we did not finalise and publish the results until April 2018.

Our GP appointment work enabled us to talk to and survey 1,286 patients across Lincolnshire. Analysis of the survey’s confirmed that we were able to capture the views of people under 18 through to over 75; working full time, employed, unemployed and retired; as well as families, carers, people with a disability and long term health conditions.

The results of our work identified a number of issues including:

For many patients difficulties getting a GP appointment was really not such a problem. We were in fact able to isolate the problem down to a small number of GP surgeries.
Staffing shortages was identified as one of the problems.
Patients did want to see the same GP each time, whilst continuity was important this was also a factor in delays.
Patients did not understand the role other clinical staff such as Nurse Practitioners and Practice Nurses have in delivering their health care.
People’s expectations are changing, more people live in an ‘instant’ society.

As a result of our GP Appointment work we have:

- - - Shared the results with 4 Lincolnshire CCG; NHS England; Lincolnshire LMC; CQC and Healthwatch England as well as many other local boards and committees. The sharing of this report highlighted the issues from both patients and GP practices across the primary care (GP) community in Lincolnshire.
    - Healthwatch Lincolnshire agreed to create a number of patient messages focusing on rights and responsibilities of patients.