Safe surgeries; improving patient access

A ‘safe surgery’ is a GP practice that takes steps to tackle the barriers faced by many migrants accessing healthcare; in practice it involves ensuring that your practice team are aware, and understand, that these barriers do exist – but that they can be overcome with ease. The Clapham Park Group Practice was one of the first safe surgeries; Marie Cahalane caught up with their safe surgery lead Dr Jenny Akhurst to learn more about the programme

According to research published by Doctors of the World – the organisation that supports the safe surgery initiative – one-in-five attempts to register vulnerable patients is refused by GP surgeries despite their being fully entitled to access NHS primary care. A safe surgery recognises the barriers to healthcare that exist – particularly for migrants and others in vulnerable circumstances – and advocates small changes that a GP practice can make to ensure that nobody in their community is excluded.

Practices that become safe surgeries gain access to training, tailored resources and a supportive national network of practices committed to improving access for all. Clapham Park Practice was one of the first GP practices to become a safe surgery – a move that was led by Dr Jenny Akhurst.

The need for a safe surgery

An essential aim of the initiative is to support practices to improve access and deliver inclusive and equitable healthcare for all. Having been a volunteer GP with Doctors of the World for about four years – working in their London clinic in Bethnal Green – Dr Akhurst had seen first-hand the volume of people who have difficulty accessing healthcare; she had previously worked with Doctors of the World to raise awareness of this issue amongst healthcare professionals.

“At the moment not everyone is able to access healthcare easily – that’s something to be aware of,” she says. “Those people who are finding it difficult to access services are likely to be from vulnerable groups – marginalised groups, such as specific migrant groups; their inability to access healthcare can, and is, leading to a widening gap between the health of these patients and the rest of the population.”

So, when Doctors of the World started the safe surgery initiative – an opportunity to be a part of breaking down those barriers to healthcare – Dr Akhurst was keen to get her practice involved as soon as possible and to spread the word to practices locally.

Simple steps to change

The barriers to access come from both sides but there are simple ways that practices can overcome them. For GP practices, the main challenge can be that GPs don’t get to see these vulnerable patients in the first place because they don’t come forward. “This might be because they don’t know that they are eligible to see a GP, or because they are not familiar with how the NHS works – how to make an appointment; perhaps they struggle with language barriers when trying to register or fill out forms, or they might be asked to provide documentation that they don’t necessarily have,” Dr Akhurst explains. However these need not be barriers, and they can be overcome.

One critical step to breaking down such barriers is training. “There’s a lot of misinformation out there about who is or isn’t eligible to register with a GP, or access certain services, and about what people need to provide in order to register with a GP,” Dr Akhurst says, adding that, in her experience, a lot staff clinical and non-clinical staff aren’t aware that everyone is able to access free primary care regardless of their nationality or immigration status.

The safe surgery initiative provides training to increase awareness, improve knowledge of these issues among clinical and non-clinical staff, and looks at how practices can make small changes to reduce barriers. Further, Dr Akhurst points out that declaring your practice a safe surgery makes you more visible to patients – making it more outwardly clear to patients who might be looking to register, but are uncertain whether they are eligible, or worried that they might asked for documentation they don’t have. It’s about making them feel safe.

A case for awareness

“It really only takes small changes,” Dr Akhurst says. “What we found was that we didn’t have to specifically change any of our policies; what we did have to do was make sure that all staff were aware that, for example, providing documentation, ID and proof of address aren’t required for patients in every case,” she says. While this had been the case all along, what was important was that this message was reiterated and that all staff – from reception to clinicians – were aware.

“Making staff aware of the kind of barriers that people face means that they might be more likely to think along those lines – to think to pick up the phone and use an interpreter if someone is struggling with language, or to give someone a bit more time in an appointment if they need it. It’s a question of just being aware of the barriers that exist for the patients and accommodating them as much as possible,” she explains.

The safe surgery lead

Dr Akhurst is the safe surgery lead at her practice; this simply means that she is the link back to Doctors of the World and the safe surgery network. She provides support to any colleagues who might need it and answers any questions that might arise. This, she says, is a role that can be taken on by non-clinical members of staff, too; it just requires them to be aware and have the knowledge – which is provided through training.

Becoming a safe surgery

For practice, considering becoming a safe surgery the message is – do it! “It doesn’t involve any big changes to how you’re working already but it does provide you with training so that all staff have an awareness and understanding of this issue,” Dr Akhurst says. In addition, it means that those people living in your community, who are in need of healthcare but unable to access it will be better served. “It basically means everyone in the practice is working from the same page – everyone in the practice has the same awareness about these kinds of issues,” she says.

The benefits of safe surgeries, and ensuring access to primary care for all, extend beyond the individual practice, Dr Akhurst adds. “If people aren’t able to access primary and preventative healthcare services they tend to end up accessing emergency health services further down the line. These services are already overstretched and this likely to be at a greater cost than primary healthcare services,” she explains.

If you are interested in becoming a safe surgery, or learning about how you can improve services, visit the main safe surgeries webpage for more information.

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