The report, based on direct feedback from 824 participants representing Gloucestershire’s diverse communities, identifies several key issues affecting access to GP services:

Communication challenges: Lack of effective communication has led to confusion and frustration among patients regarding appointment booking processes, triage systems, and the roles of different healthcare professionals.

Accessibility issues: Patients with accessibility challenges, including language barriers and technology use, face difficulties engaging with GP practices. Issues were identified among specific demographic groups, such as those aged 25-49, individuals with various health conditions, and people whose first language is not English.

Appointment-related frustrations: Patients expressed frustration with the wide-ranging time slots for GP calls, and the need for separate GP appointments for each issue which they felt to be inefficient and caused delays for diagnosis and treatment.

Technology disparities: While some patients are keen to use digital options for accessing GP services, people expressed frustration at disparities in availability, complexity, and effectiveness of digital services across GP practices in Gloucestershire. It was also noted that the Apps used are not always easy to use and they are only in English.

In response to these findings, Healthwatch Gloucestershire has made several recommendations to help improve access to GP services in the county. These include:

• Better communication about the different services, clinics and staff available, through informative leaflets, displays, newsletters, and open events.
• Improving accessibility through diverse appointment options, extended use of video appointments, clear pathways for interpreter requests, and information available in other languages and formats.
• Addressing appointment-related issues with longer appointment options to discuss multiple issues, advance booking for regular appointments, and shorter time slots for GPs to return calls.
• Tackling technology disparities by ensuring that GP websites and apps are up-to-date and provide the full range of digital GP services available, working with Digital Hubs to provide basic IT training to local people, and introducing change of language functions on websites and apps.

Lucy White, Healthwatch Gloucestershire Manager, said: “People often tell us that accessing GP services in Gloucestershire is difficult. In recent years, there has been increased pressure on GP services and a growing demand for GP appointments to be offered in a variety of ways, with rapid acceleration of digital and remote methods due to the pandemic. We have reported our findings to NHS Gloucestershire and other health and care leaders and provided actionable recommendations to support ongoing service development and improvement.

“Over 800 people took time to share their experiences and feedback with us. I’d like to thank them, and the local groups who helped us reach and hear from our diverse communities, to help improve access to healthcare for everyone.”

Becky Parish, Associate Director, Engagement and Experience NHS Gloucestershire, welcomed the report and provided a detailed response to the recommendations made by Healthwatch Gloucestershire: “Thank you to Healthwatch Gloucestershire for preparing this insightful report. We are pleased that so many people have taken the opportunity to share their views about access to GP services and we were pleased to work alongside Healthwatch Gloucestershire to ensure the voices of underserved communities were  heard. The report’s findings underscore a number of areas NHS Gloucestershire is already working on with primary care colleagues and identifies some new areas for us to focus on.”

Read the full report: Accessing GP services in Gloucestershire

The Trust has released a statement saying: “We are deeply sorry that failings in our care led to these tragic deaths and how devastating this has been for those families. We are determined to learn and change when things go wrong. As a result of our internal and independent investigations we have made significant improvements to our maternity services in the past three years.”

Read the full statement, as well as some ‘Frequently Asked Questions’ and services that can offer support.

We are pleased that GHNHSFT have taken proactive steps to ensure a route for these concerns to be shared and for questions to be answered. We urge the Trust to engage with families in a purposeful and intentional manner, involving them in the decision-making process regarding their care.

It is essential that every family, regardless of their background or circumstances, has equitable access to the support and information they need during their maternity journey. Gloucestershire Hospitals NHS Foundation Trust’s Maternity Services must actively seek the perspectives of all, including staff and those patients and their families who may face challenges in accessing necessary support.

Healthwatch Gloucestershire remains committed to ensuring that the voice of our communities across Gloucestershire is heard and acted upon, and we call upon GHNHSFT to continue striving for improvement in maternity care.

In recent months, many people have contacted Healthwatch Gloucestershire to feedback about their negative experiences of urgent and emergency care in the county, including waiting hours for an ambulance or being held for long periods in queues outside A&E, being told to transport themselves to hospital, and most commonly, waiting for hours in A&E with no indication of how long they will be there.

Through a survey and community discussion groups, Healthwatch Gloucestershire wants to build a fuller picture of how people are using services locally. They will use the feedback they gather to assess public knowledge and understanding of the different urgent care services available across the county, and to recommend how the NHS can improve patient experience and confidence in the care being provided.

Launching the new public engagement project, Lucy White, Healthwatch Gloucestershire Manager, said: “When people need care urgently or in an emergency they have to act fast. If they know which service to use and they are confident they will get the care they need from that service, they are more likely to choose well. When patients are treated by the right service, as soon as they need care, this can lead to better outcomes. It can also help to relieve pressure on services by allowing health care staff to focus on their particular area of care, for example allowing Emergency Department staff to treat life-threatening emergencies rather than urgent minor injuries or urgent dental issues. Please do share your story with us to help make care better for you and your community.”

The report sheds light on the challenges faced by individuals needing care and their unpaid carers, providing valuable insights into the strengths and weaknesses of the current system.

Key findings:

• Timely support is crucial: Frequently, individuals reach out to Adult Social Care in moments of crisis, necessitating swift information
  and support.
• Navigating social care services: Many people find it challenging to understand and access the array of social care services available, highlighting a need for improved user-friendliness and accessibility in service information.
• Assessment terminology: The use of multiple similar terms like Care Assessment, Care Needs Assessment, Initial Assessment, and Social Care Assessment can lead to confusion and varying interpretations.
• Information about the Care Assessment process: Many people are unaware of the process and approximate timescale for obtaining a Care Assessment, deterring them from seeking one.
• Clarity in communication: The GCC website could benefit from clearer language and navigation, ensuring accessibility to a wider audience.
• Consistency is key: Inconsistent communication and experiences can lead to vastly different outcomes for individuals.
• Empowering individuals: It’s essential to ensure that individuals are aware of their right to have someone support them during all calls and meetings related to the Care Assessment.
• Reducing repetition: The repetition of personal stories to multiple professionals can be exhausting and discouraging for individuals seeking social care support.
• Named contact for queries: Providing individuals with a designated contact person can facilitate smoother communication and reduce the need to repeat their story.
• Lack of support for self-funded care: Individuals self-funding their care reported a notable absence of information, signposting and ongoing support, from the GCC Adult Social Care team.
• Unmet needs: There is a significant risk of people in need of social care support, and their unpaid carers, having unmet needs. This can lead to deterioration in health and increased demand on health care services.

In the report, Healthwatch Gloucestershire recommends several actions that GCC can take to address concerns raised around communication, information, consistency and access to social care. The recommendations are designed to benefit local people and also to ensure GCC is meeting its legal duties under the Care Act, three of which incude: to prevent, reduce and delay people’s needs from getting worse; to provide information for local people about care and support; and to provide a range of services for people to access.

Announcing the report, Lucy White, Healthwatch Gloucestershire Manager, said: “We set out to listen and learn from those who seek support from social care services, so that we can make clear and impactful recommendations for change to enhance the Care Assessment process and social care support provided to Gloucestershire residents. We want GCC to consider and implement these recommendations to develop a more inclusive, accessible, and supportive social care system for individuals and unpaid carers in need.”

Emily White, Director of Quality, Performance and Strategy, Adult Social Care at Gloucestershire County Council, has welcomed the report and responded in detail to the recommendations for improvement, commenting: “This report provides us with more evidence to support our improvement plan and approach. We are aware of the challenges faced by people who use our services, particularly in relation to our capacity to meet demand. Our new Customer Experience role within our Transformation team will help to address some of the recommendations in relation to information accessibility and how we communicate with people and their families and carers in a simple way about the Social Care Process and what to expect.”

Read the full report

How can people’s social care needs be better assessed and supported? The perspective of those in need of care and their unpaid carers

Healthwatch Gloucestershire’s report, Supporting people to stay healthy and well as the cost of living rises, analyses feedback from almost 400 local residents, and organisations involved in providing services, to identify common challenges faced by communities in Gloucestershire.

• Choosing between essentials: Many people are grappling with the difficult choice between basic necessities like food, heating, routine medications, dental care, and essential care services for their loved ones. This financial strain is affecting both mental and physical health.
• Pockets of poverty across the county: The research identifies pockets of poverty within every district of Gloucestershire, including areas typically considered more affluent, like Cheltenham and the Cotswolds.
• The ‘working poor’ are badly affected: The report reveals that those in work who were ‘just about managing’ previously, are now struggling due to low household incomes, not qualifying for benefits, and costs associated with childcare and school-age children.
• Lack of affordable transport: The lack of accessible and affordable patient and community transport, especially in rural areas and outside regular working hours, emerges as a major hindrance to accessing health and care services. This leads to increased stress and missed appointments, as well as wasted time for health services.

Healthwatch Gloucestershire makes several recommendations for how health and care providers could improve support to help those grappling with rising living costs access services.

• Support and signposting: Train frontline healthcare staff to recognise and address issues related to the cost of living and improve signposting to relevant support services.
• Prescription costs: Explore options to subsidise prescribed treatments, like the Warm Home prescription pilot scheme, for people at risk of health deterioration due to financial constraints.
• Dental care: Improve availability of NHS dentist appointments, particularly for urgent cases.
• Digital access: Ensure accurate and up-to-date information is available online to help people access services such as community transport, and increasing support for those who face barriers to using digital services.
• Transportation: Collaborate to commission more reliable and affordable transport services, especially in rural area and off-peak hours, to make it easier for people to get to medical appointments.
• Food security: Raise awareness about existing support schemes like the NHS Healthy Start programme and promote additional services provided by food banks.

Read the full report

Supporting people to stay healthy and well as the cost of living rises: What are the challenges and what support will make a difference?

Healthwatch Gloucestershire’s report echoes national findings. Read Healthwatch England’s evidence on the problems people are facing and how they believe these can be reduced to ensure cost is not a barrier to accessing care.

This research is in response to ongoing concerns raised by local people. Access to GP services is one of the most common topics people contact Healthwatch Gloucestershire about, including problems booking appointments, long waiting times, and concerns about the use of digital technology and remote consultation methods to deliver care instead of in-person communication.

Lucy White, Healthwatch Gloucestershire Manager, commented: “Good access to GP services is an important measure of the quality of care being provided locally.  It also helps reduce pressure on other services. We have highlighted people’s concerns previously in our 2021 and 2022 reports, so we are looking again to understand what can be done differently to improve residents access to care through GP practices, particularly around getting an appointment, communication with staff, and the use of technology to deliver services.”

Making a difference locally and nationally

The insights gathered through this research will be shared with NHS Gloucestershire to help them understand the current challenges surrounding access to GP services and its impact on local residents.

Healthwatch Gloucestershire will also share public feedback with Healthwatch England, to inform their national research and campaigns around access to NHS services. Read their recent research showing a third of people in England lack confidence they can access critical NHS services, including GP care.

Healthwatch Gloucestershire published 11 reports last year about the improvements people would like to see to local services, covering a broad range of topics including:

• Making GP services more accessible
• Improving access to paid care at home services
• Reducing digital barriers to health and care services
• Improving communications in health and care services
• Improving the autism assessment process and support for adults with autism
• Developing social support to help young people manage their mental health
• Better access to NHS dental care
• Monitoring and improving the quality of care homes.

Healthwatch Gloucestershire shared all the reports with NHS and social care leaders and their recommendations are being used to guide service developments in the county.

Announcing the annual report, Nikki Richardson, Chair of the Healthwatch Gloucestershire Board, said: “Last year, one of our key priorities was to tackle inequalities around access to health and care services. We focused our work on people rather than specific services and we sought to champion the voices of those who are often unheard. We shared people’s stories and feedback to highlight the challenges and barriers people can face when they try to access services. We used this insight to help health and care leaders understand how to improve access to care for everyone in our community and we challenged local providers to deliver the high quality, responsive services that people in Gloucestershire want and need.”

Commenting on Healthwatch Gloucestershire’s work last year, Becky Parish, Associate Director, Engagement and Experience, NHS Gloucestershire, said: “NHS Gloucestershire ICB has greatly valued many opportunities for partnership working with Healthwatch Gloucestershire in the past twelve months. Highlights have included: co-development of the new ICB Working with People and Communities Strategy; sharing and discussing patient stories; and working together to improve the accessibility of information for local people.”

Healthwatch Gloucestershire also announced four public engagement projects that it will work on during 2023-24:

• The impact of the cost of living crisis on people’s ability to access health and care services
• The quality of information, services and assessments for Adult Social Care
• Urgent and emergency care
• Access to GPs.

Read the report

Healthwatch Gloucestershire Annual Report 2022-23