1. Primary Health Care: GP Services and Young People Jonathan Smith, CEO and Charlotte Connolly, Young People’s Network Co-ordinator: Child Health Development Programme

2. Introduction Why listen to the voices and views of young people? Why choose the issue of primary care services?

3. Summary This study was requested by the CHDP to discover the views and opinions of Cheshire and Merseyside’s young people around the subject of GP services. The research was commissioned in light of current government discussions around NHS funding, as well as the “You’re Welcome” kite mark introduced by the previous government. Its aim was to discover the views, opinions and experiences of young people around GP services, and to highlight any areas in need of improvement

4. Method Peer research 45 min workshops 7 participating schools and colleges in Cheshire and Merseyside. Working with 123 young people aged between 11-18 chosen by the schools and colleges. Both qualitative and quantitative methods.

5. Findings/Conclusions/ Recommendations

6. 1. Lack of understanding of roles in GP surgeries

7. finding Many young people were unsure of the role of a GP. When asked to write down everything they knew about GPs, many of the young people were confusing GP surgeries with hospitals, walk-in centres and other health care practitioners.

8. finding 61% did not know there was such a thing as a practise nurse 63% of the young people did not understand the role played by the practise nurse.

9. finding

10. conclusion Many young people are unclear of the exact role and purpose of a GP surgery and what services it can provide.

11. recommendation Send out information to community, local schools colleges youth groups detailing exactly what services you provide and their times and location.

12. 2. Opening times

13. finding 68% of the young people we consulted with spoke about the need for longer or alternative opening times either in the evening or at weekends. Young people felt that they could not access their Dr at convenient times with out first taking time off school or college.

14. conclusion Opening times are too restrictive for young people in full time education

15. recommendation Extend opening hours after school/ college and weekends, even if only for one day a week. If this is already in place, make sure that it is promoted and publicised to young patients.

16. 3. Appointment booking

17. finding 40% of the young people we spoke to believed it was difficult to get an appointment at their GPs A large number of the young people expressed their dissatisfaction with the appointment booking experience. “You have to call at 8am to get an appointment but by 8:15 their all gone. You can’t pre-book them either”.

18. finding Many young people also felt deterred from booking appointments just to “ask questions” or for “health check ups”, as they felt getting an appointment was so difficult they did not want to waste time that some one who was ill could use.

19. conclusion The process of booking an appointment is restrictive and inconvenient, leaving many young patients feeling deterred from booking appointments, especially if only for a minor issue or query

20. recommendations Allow patients to book either on the day or in advance, to give them the opportunity to book appointments best suited for them Promote, to young patients in particular, the preventive services and clinics held by the practice, so that they are aware of the best time and day to book. Introduce a specific young person’s clinic one day a week, to encourage young people to access GP services to get advice health check-ups etc.

21. additional recommendation One young person spoke of wanting something more personal and specific than the NHS choices website He had a very strong suggestion for an electronic question-and- answer system. Young patients could either privately e-mail the GP surgery, or anonymously post on a website Questions would be answered, either privately, or posted on the website for advice with the query.

22. 4. Waiting times

23. finding 57% of the young people said that they wait too long, in the surgery, after their booked appointment time. When asked what changes they would like to see made at their GP surgery, the majority of the young people suggested “the waiting time”

24. finding

25. conclusion Young patients are left waiting too long after their booked appointment time

26. recommendation Young people suggested that, if there was a problem with waiting times, they would like clear communication from the surgery, to say that there is going to be a wait, that this is because each patient is getting the full attention of the GP, and that, if it is inconvenient, they would be offered a different appointment time.

27. 5. Reception staff/confidentiality

28. finding 39% of young people we spoke to felt the staff at their GP surgery were impolite and unhelpful. Fears were also expressed about breaches in confidentiality in surgeries where patients were asked what they wanted to see the doctor for, in open public spaces. Many young people expressed how they felt intimidated by this situation.

29. finding The attitude of reception staff was also commented on, with a number of young people suggesting staff were “rude” “inefficient” “chatty” “unfocused”

30. conclusion Young patients feel intimidated by the process of checking in, believing there is a lack of confidentiality and that reception staff have poor customer service skills

31. recommendations Provide self check-in facilities in all GP surgeries, to relieve any intimidation young people may face. Provide customer service training for all staff on reception. Have customer satisfaction survey forms readily available in surgery. Monitor and act-upon, the results of these surveys

32. 6. GP knowledge

33. finding young people believe that their GP is not fully equipped with the knowledge to treat them. “Drs who know what is wrong with you, better solutions, I tell them my symptoms and they don’t answer they just fob you off with pain killers”

34. conclusion Some young people believe their GP is not fully equipped with the knowledge to help them. They believe GPs will use painkillers and repeat antibiotics to “shut you up” instead of doing further tests or referrals

35. recommendations Increase communications between GP and patient during diagnosis, and whilst prescribing a course of action. Explain fully what is being prescribed and why, allowing young patients to feel confident in the doctor’s choice, or to question it if they are uncomfortable with the prescription.

36. 7. GP attitude

37. finding 55% of young people believe their GP is unfriendly: “They need a better bed-side manner” There was also a clear trend appearing in the answers that wanted a relationship between Dr and patient where: “Drs who know who you are.” “A Dr who will chat with you.” “A Dr who will make jokes with you and laugh.”

38. finding Differences between the attitudes of nurses and doctors were discussed: “The nurses chats to you, they care, you can tell them your symptoms and they try find the best solution for you. Drs just give you some painkillers and tell you to get out.”

39. conclusion Young patients feel intimidated by their doctor, and suggest that they are “unfriendly”.

40. recommendations Train GPs in working with young people, or, at least, in gaining an understanding of how it feels to be a young person in a GP surgery Alter their attitudes accordingly, i.e. keeping patient relaxed, reassured and safe.

41. 8. Waiting area design and facilities

42. finding 55% of the young people we spoke to said they felt uncomfortable in the waiting area of their GP surgery. “boring” “smells funny” “uncomfortable chairs”

43. finding Young people felt that, if they had to spend so long waiting in them, they wanted something to do. This was not simply down to boredom, but also to anxiety: as previously mentioned, the young people felt intimidated by their GP surgery waiting area, as well as by their GPs. They wanted something to make them feel comfortable.

44. Café, coffee machine, vending machines. T.V, Music, X-box 360, Fish Tank, fabreeze radios in the seats with headphones attached and a screen that showed a patients name when it was time for them to go in”.

45. conclusion Young people feel uncomfortable, bored and intimidated by the waiting area at their GPs

46. recommendations Introduce activities into the waiting room that relax young patients and make them feel comfortable. Change the smell and seats in the surgery, which will impact on young patients’ experiences at the GP surgeries

47. recommendations continued inter-active quiz on public health issues such as alcohol use, which could give the GP surgery information about local alcohol usage, and would also provide information for the patient on the subject.

48. Final statement Overall, I think that the research findings are very substantial, as many young people across Merseyside and Cheshire had similar views on GP services. They highlighted areas for change and improvement. I hope this research will promote future changes to the services, and encourage everyone to take into account suggestions from young people to improve services and relationships between GP’s and Young people. Jenny Roberts

49. Thank you, any questions?