Three Leyton GP practices are now in special measures after damning inspections
By Josh Mellor, Local Democracy Reporter
Patients of three “inadequate” GP practices in Leyton have complained that their reception staff are “unqualified gatekeepers” whose “goal is to offer the minimum possible care”.
A local healthcare watchdog has analysed patient feedback after a third surgery in the south of Waltham Forest received the lowest rating from government healthcare inspectors in last month.
The Ecclesbourne Practice, the Francis Road Medical Centre and Crawley Road Medical Centre are all in danger of being shut down by the Care Quality Commission following damning inspections in the last year.
After looking into the source of the problems, a report by Healthwatch Waltham Forest has warned that a lack of face-to-face appointments is undermining patient trust in their local practices.
They said: “[Patients] are more likely to perceive reception staff as rude and the relation with them as adversarial; they may be seen as unqualified gatekeepers whose goal is to offer the minimum possible care.
“If they are offered remote consultations (for example, a call back from a doctor on the phone or an online consultation) they are likely to see this as being of lesser quality.”
One anonymous patient at Crawley Road practice – which has been given a final warning to improve – said they get a “sick feeling” about having to deal with reception staff.
They added that receptionists are “patronising and act as gatekeepers” to accessing medical care from a nurse or GP.
Another told Healthwatch they would “most likely” get a telephone appointment with a ten-minute time limit, which doctors will “enforce”.
Patients of Francis Road Medical Centre told the health watchdog they did not trust diagnoses they received during a telephone appointment and did not feel “involved” in their own care.
The surgery’s patients also raised concerns about the speed prescriptions were dealt with, with one suggesting the practice’s service deteriorated after a new manager took over.
One told Healthwatch: “Reception never passes messages to GP, and it’s very exhausting to try and get anything resolved as there’s never appointments.”
At each practice, Healthwatch Waltham Forest found that two-thirds of patients spoke negatively about the service offered, particularly about reception staff acting as “adversarial gatekeepers” for appointments.
Speaking at a health and wellbeing meeting on 15th March, the local watchdog’s chief executive Dianne Barham said the pressure on GP practices is causing some to “show outbursts”.
Her report on patient feedback found that if patients are unable to get a same-day appointment, they are given “no appointment at all”.
The report added: “Instead, they are advised to access urgent care which may not fully meet their needs or keep trying with no guarantee of an appointment.”
Phone lines can become “even more overstretched” if online appointment booking or e-consult does not work.
Lorna Hutchinson, assistant head of primary care at NHS North East London, said her team is “streamlining intervention” to support practices that fail inspections. She added that NHS North East London is also able to monitor the “contractual levels” of service practices are delivering.
Despite widely voiced concerns about a shift towards phone appointments, NHS North East London, which commissions GP services, insists that appointments are provided according to “patients’ preference and clinical need”.
Responding to the Local Democracy Reporting Service in November last year, a spokesperson for the NHS body said approximately 65% of appointments are face-to-face.
They added: “The role of the receptionist is not a clinical role; however, they will try to get the patient to see the most appropriate healthcare professional within the multi-disciplinary team in the practice.
“There isn’t a universal approach to the role of receptionist, as it will depend on each individual practice.
“Practices are focusing upon the multi-disciplinary role of their team but if patients are unhappy with the response they receive from the receptionist they can complain to the practice manager in the first instance.”
However, due to the way surgeries are contracted to provide health services, the NHS does not have an “explicit role” overseeing receptionists’ roles.