Improving care Reports GP premises: the patient perspective Poor confidentiality at reception desks, issues with access for disabled people and dated waiting rooms are some of the biggest problems highlighted by patients in a new report published by the Patients Association of people’s views of their local GP surgery’s buildings. The report has found that patients are concerned about various internal and external aspects of their local GP practice premises. The report outlines patients’ views based on an online survey and four focus groups aiming to establish the importance of the physical environment in shaping people’s experiences of primary care. Confidentiality emerged as a key issue raised by patients, particularly the risk of being overheard at the reception desk or when telephoning practices. Of the 720 respondents to the survey and focus groups, 58% (404 of 692 respondents to this question) said that there was not enough space at the practice to allow reasonable privacy. Some patients said it was “impossible” to speak to the receptionist without being overheard, while others claimed that privacy at the reception area “wasn’t good”. NHS staff are legally bound1 to protect and conserve patient confidentiality at all times, and it appears from patients reporting their experiences for this project that buildings are not always conducive to this. Access for people was also highlighted as a concern, both in terms of physically getting to the building, and in accessing the building. While 75% of respondents said there was a ramp at the entrance to the building, less than half (46%) of respondents reported that their building had a lift. There were a number of comments from patients reporting difficulties caused by poor building design and access: No lift and the corridors are narrow Doctors having to come downstairs to see patients Difficulties in moving around the buildings in wheelchairs Difficulties in being able to get into the building easily or get to the reception desk due to lack of space to turn and manoeuvre. Travelling to GP premises emerged as a concern: both public transport and travel by car were commonly cited as difficult, the key problem in the latter case being parking. In some instances this was because the buildings were in urban areas, sometimes above shops, and in others buildings were on busy roads with no space for extra parking. This was a problem especially for people whose mobility was poor or where the surgery was a substantial distance from their home. People commented that they attached value to a practice being close to their home. Four in ten respondents stated that their GP practice was a poor environment that made them feel anxious or stressed. With a growing body of research2 suggesting that bright, comfortable and well-designed spaces promote healing and have a positive effect on patients and staff, it is worrying that so many buildings are inadequate and lacking in a comfortable environment for patients. While it was clear from this project how highly patients value the NHS, it was also clear that the buildings that house general practice in particular are often old and in need of serious investment and expansion based on the feedback from the participants of this survey. If current pressures on the GP workforce are not resolved, at least some care will have to be provided in very different ways in the future, and buildings will be an integral part of that. There are common threads in the concerns patients have regarding their GP premises but they are also very forgiving of shortfalls in the standards of buildings as the perception is that available funds should be spent on care. This came through in some of the comments made during the focus groups and in some of the qualitative comments in the survey. Also, people do believe that an agreeable environment implies they are welcome and valued. Conversely, a poor environment can be a source of stress, anxiety and cause increased feelings of ill health as well as doubts about whether lack of cleanliness, tidiness etc. is a reflection of the standard of treatment. Rachel Power, Chief Executive of the Patients Association, said: “It’s a huge concern that the majority of people completing our survey reported issues relating to privacy and confidentiality at their local surgery – this goes against the law and official NHS guidance, and needs to be addressed. Patients who are sick and unwell will already be anxious about going to see a GP – the last thing they should need to worry about is whether their private conversations will be overheard by other people. “We recommend that all existing and new GP premises should ensure that people with disabilities are able to easily access the building and internal rooms, and that health and safety and disability legislation is always applied. Our other recommendations are based on what patients have told us they want to see: adequate parking and good transport links, improved signage throughout buildings and better air quality control in waiting rooms. “Despite the concerns that people have, it’s clear that patients value the NHS and seek high quality care as a first priority when they visit their GP. Funding should primarily go into improving standards of care – and patients agree that this should be the case – but it should not be ignored that many buildings housing general practice are often old and in need of serious investment.” Download the full report here. Find out more about the report here. References NHSE Principles of Confidentiality June 2016 - All employees working in the NHS are bound by a legal duty of confidence to protect personal information they may come into contact with during the course of their work. This is not just a requirement of their contractual responsibilities but also a requirement within the common law duty of confidence and the Data Protection Act 1998. It is also a requirement within the NHS Care Record Guarantee, produced to assure patients regarding the use of their information. The architectural healthcare environment and its effects on patient health outcomes: a report at the end of the first year of study. 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