GPs and Young People: Better together than apart

On 5th November 2013, I had the pleasure of being invited by the lovely Kath Evans to speak alongside her at the ‘One Day Essentials: Child Health’ event at the Royal College of General Practitioners (RCGP). During this event I had the pleasure of sharing my experience with regards to GP services, as well as presenting possible solutions to issues that other young people and myself came across when accessing GP services. This blog serves to highlight some of the feedback I shared on the day as well as thoughts and reflections from research I carried out after the event.

Children and young people make up at least one in seven users of GP services and therefore it means that these services should take this responsibility seriously and ensure that they listen to and act on the views of children and young people. They should listen especially when what the children and young peopl ahve to say is uncomfortable or challenging.
GPs form the basis of a lot of conversation at the RCPCH Youth Advisory Panel (YAP) meetings. We admire GPs for the amount of work they have to do, as well as respect them for the amount of responsibility they have. They act as the main point of contact of care for our parents and families.

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According to a document produced by the RCGP states the main roles of a GP and they are the following:
“GPs are to act as your family doctor and to be the main point of contact for general healthcare for NHS patients.”
“GPs are also to act as a patients advocate, supporting, representing a patients best interest to ensure they receive the best and more appropriate health and/ or social care.”
“GPs also provide the link to further healthcare services and work closely with other healthcare colleagues to help develop these services.”

These services have worked very well, at least in my experience for my parents and their friends. However, for people like myself, GPs can often leave us wanting. It was further concerning to learn in a CYPNow article that “staff in GP, mental health and sexual health services said that they were not always trained to receive and act on complaints made by children and young people.” This is rather a disconcerting matter which I shall try to touch upon later.
The Chief Medical Officers latest report states that all children and young people with long term conditions must have a named GP, but we say it is not just important that we have a named GP, it is more imperative we have an active GP.

Personal Experiences

My experiences with my GP have been rather a roller-coaster. My GP has always been very caring of my parents and have taken good care of them. However, in my experience the GP seems to take an attitude of not wanting to treat me. Or at least that is how I felt. My GP always seemed to take the view that it was better to send me to A&E to be treated even if it was something that could be treated with their practice, i.e. a chest infection. This was down to their belief that they may prescribe me something which may interfere with the medication which I was already under due to my existing medical condition.
Thankfully, having moved to a different GP due to going to University, the GP seems to be a bit more hands on and actually willing to treat and diagnose me. Which is a bonus. Though, in finding a GP having moved to University was an ordeal in itself. Most of the practice surrounding my university were not wheelchair accessible, which more than anything was a sheer annoyance, this goes for dental practices around the area as well as London.
Another gripe, I could say I have with my experience of GP services is in regards to their operation times. They operate in a very traditional method, with bookings having to made at a specific time of the morning if you need a same day appointment and operate from 9am - 5pm. While this is the norm, it often means that if I wanted to go to see my GP I would need to either take time off school or move around my extra curricular activities in order to fit in these appointments. While working professionals and adults may say that this is similar to how they would have to see a GP, it is a more difficult scenario for young people. For starters, those with long term conditions especially, already may have to take time off school/ college in order to see to their health needs or to see their consultant which is inevitable leave. Therefore, to take even more time off to see your GP is an additional amount of time off. This has sometimes put me off seeing my GP until things got really bad.

While I thought my case may have been an isolated one, it proves not to be the case. Having looked at reports from the Care Quality Commission (CQC), Right Here, the Children’s Commissioner for England and Healthwatch Warwickshire, and heard my friends from the RCPCH YAP tell their stories, the feedback coming through from other young people seems to have common themes. I have highlighted some key quotes and findings below:

“Doctors not understanding enough and did not listen to my worries, doctors just spoke to my parents”
“Feels like they [Doctors] don’t want to be there”
“They seems to feel like they are always rushing”
“They ask the wrong questions, i.e. are you okay? Obviously I am not Okay! They should ask ‘what is wrong?’”
Young people worried about not being taken seriously and that professionals held a stereotypical view of young people.
“It is not made clear whether interactions with professionals are confidential or not.”
Traditional operation of GP services did not fit in with children and young peoples wishes, this has led to a lack of continuity and a lack of opportunity to build relationships with one GP.

Recommendations

Obviously the situations outlined above can be rectified, one way is through collaboration between GPs and young people. Young people should not be made to feel that they cannot speak to their GPs about issues that are affecting them, and they should not be made to feel that they are being a hassle. The relationship that exists between GPs and young people needs to be one of accessibility, communication and trust. Therefore, using ideas of how the service can be improved, combined with recommendations from members of the RCPCH YAP and the reports I’ve read, I would like to present 7 recommendations which we as service users and you as GPs and healthcare professionals can work together to improve our the provision of this service within the NHS.

1. Communication Training -> Communication between young people and GPs are vital and it is important we get it right. Therefore having GPs who can communicate with us in our language, without the use of jargon is essential! Communication isn’t just verbal but it also comes in the form of body language and attitude. I have often heard from young people that younger GPs tend to be able to emphasize more with young people, especially those with long term conditions, than older GPs. Obviously that is not a hard and fast fact across the board, but it seems to be a trend and a trend which can be changed. While GPs have some level of communication training now while studying at University, this was not always the case. Therefore, it may be beneficial if refresher courses for communication was included as part of a GPs professional development every ten years or so.
2. Increased levels of collaboration -> The RCPCH YAP have often said that collaboration can lead to better outcomes, and it is no different when it comes to GP services. If anything collaboration from and with your GP could be the most important thing to have in place. We, as young people. want to have join up work between our GPs and our consultants and our other specialised services. We want to see them working as a team and working with each other. We would like to see GPs to act as our champion and also be the champion for the ‘one point of contact’. We are supposed to see our GPs as our first point of contact for issues we are having, therefore it would make sense for GPs to be at the centre of our care structure. This would help to provide care that is consistent and personalised. Also it would act as a mechanism to ensure things don’t get missed and it is followed up, rather than the different teams within your care delegating and pushing actions on to others and therefore delaying things, ultimately effecting outcomes for the young person, be it socially, emotionally or psychologically.
3. Nurses -> We understand that GPs have a significant work load and have a lot of patients to see, including us. However, to alleviate some of the pressures of keeping an eye on us all the time and having regular appointments, I would suggest using the nurses in surgeries in an extra capacity. Again, young people have often stated that nurses are often found to more approachable than GPs, so I would recommend checking if it was possible to get a nurse to check on the young person, especially those with long term conditions who may need to be monitored, first and then refer them to their GP if necessary.  Another recommendation would be to see if there was a chance to employ chronic patient nurses, to pick up this extra duty if the regular staff are inundated and cannot pick up extra work.
4. Transition -> Transition, as often I have often stated, is a very important part of a young persons life and therefore is important that it is managed well. Transition services have been said to be inconsistent across the UK, and with the help of GPs I believe that transition services can start to become more equal. As GPs are supposed to be our main point of contact for general healthcare purposes, I would feel that GPs needs to adopt the holistic care of young people. Most young people with complex conditions have expressed that their consultants take on this role until transition but after that point they feel lost. Therefore, as GPs are in the best place to carry a holistic approach throughout a young persons life, it could be part of a GPs job description. Young people with complex or long term conditions have many physicians who only deal with their speciality, but we want someone who can treat and assess us as an individual and not for the specific condition. In order to achieve this kind of care, we would suggest offering longer appointment times to young people, especially those with long term and/ or complex conditions. The practicalities of which I will explore in the next section. Also, when a young person is going through transition, they are being discharged from services and people they have been treated by for most of their lives and for some this can be very difficult. Losing that consistency, however, if the GPs role was bolstered than there would be a certain level of continuity and consistency in the young persons care.
5. Accessibility to service -> Young people, especially those in late teens, have often expressed their distress in trying to get services which is accessible and convenient for them. Young people, especially those with long term and complex conditions already have to take time off school/ college to go to appointments and treatments, which is already hard enough but needing to take extra time off to go to see their GP can cause even more inconvenience. To this end, there have been a few recommendations which can be mentioned. Young people have stated that they wish to have after hour surgeries, which is something I strongly support. One young person from the RCPCH YAP has said that “during my gap year I could go to more appointments, but now I am at university it is much more difficult”. While we understand due to costs, this may be difficult to offer at all surgeries, but we would like to see surgeries in one area teaming up to offer specialist after hour clinics for children and young people who need them. We would also like to see an increased shift away from the traditional method of booking appointments, while it may suit adults, for younger people phoning in at specific times to book appointments doesn’t always suit. Therefore, we would encourage the use of apps on smart phones, online booking to a greater number of surgeries to increase the levels of accessibility. There is a app which is making it’s way onto the scene called ‘Patient Access’ which allows people to book appointments straight from their phone, this is the type of thing we would like to see be more prominent and a service offered by more surgeries.
6. Increased involvement of Children and Young People in service development -> The involvement of children and young people in service development is something we have seen in many parts of the NHS in the past few years. This can be seen by the youth forums existing within hospitals, within the RCPCH and within NHS England itself. The young people have proven themselves to be very useful in terms of listening and collaborating with healthcare professional to come up with better solutions, together. To this end, I would feel it beneficial to have young people on more CCGs or at least advising them. I have been personally approached by several GPs asking how to get young people more involved in their service improvements, and my most general response has been just ask them. Young people want to get involved, they just need to know that there are opportunities to do so and that their involvement will not be tokenistic. One way young people can be involved in helping improve GP services, is through having young people inputting into the training of the practise staff. This can be done through the service developing a group of youth experts who can go into surgeries to advise on consultation and communication skills, etc in relation to children and young people. Obviously, young peoples experience can be utilised in many other ways, such as designing children and young people friendly leaflets, and waiting areas, etc.
7. Feedback -> Feedback is very important, feedback not only helps services to understand what works well in their surgeries but also what can be improved and done better. Also what needs to happen is GPs need to know what to do with that feedback once they get it. As mentioned before don’t know how to deal with complaints when they come from a young person. However, first it is important to get feedback, some young people are scared to provide negative feedback in fears that the quality of service they receive will be effected. Therefore, having more anonymous ways of providing feedback either online or in the surgery away from the receptionists and staff. Also the benefits of having an app is that it can be age appropriate rather than the standard, one size fits all way of providing feedback. Another reason young people may not provide feedback is because they feel that their feedback isn’t meaningful. To counter this there needs to be clear pathways displayed which illustrates how the feedback will be dealt with and a procedure that is in place to follow up if you feel your views aren’t being taken into account. A way in which GPs could more effectively deal with the feedback provided by young people, is to use young people as a way of going through the comments and collaborating to come to a middle ground. If GP services had a panel of youth experts to whom they could go to with the feedback they have received and discuss it with them and see what can be done would solve some of the issues or at least provide a way of shedding more direct feedback to their responses

Conclusions

While I have stood to point out the issues that young people seem to face with GP services, I have also aimed to provide some solutions and ideas in order to try and make the services better for all users. I do this because I am a firm believer that “we [young people] don’t just a want a good enough health service, we want the best possible health service”. This is why we need effective GPs in order to achieve the best possible health care. We believe that through having effective GPs we would be working towards greater levels of integration between health care serves. Which ultimately, we believe that if we were to achieve this scenario we would see GPs taking a more leading role in this.
To conclude, I would like to leave you all with 3 C’s which seem to be rather fitting for this scenario, Compassion, Confidentiality and Clarity!

Links to all documents and pages, referred to and used to help compile this blog!

Link to CYPNow article: http://www.cypnow.co.uk/cyp/news/1073938/young-people-feel-unable-complain-poor-health-services-report

CQC Report on GPs
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It takes a lot of courage
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Getting it right for young people in your practice
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It's your practice: A patients guide to gp services
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Healthwatch Warwickshire YP GP experience survey
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Right Here report on GPs
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