kaizen report on the community consultation and engagement ... · kaizen report on the community...

January 2015

Kaizen Report on theCommunity Consultation and Engagement

For

Brighton & Hove CCG and Healthwatch B&H

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Context 3

Targets 3

Aims 4Framing the research questions 4

What we did 5Phases of the Engagement and Research 5Methodologies 6

Individual interviews 7Pop-Up / Street Focus Groups 7Clinician and Community Engagement Specialists 7Consultation

Where we engaged people 8

About the Data 9Limitations and reliability 9How we have presented the data 9

Key statistics 10

Who we consulted with 13

Being Healthy 19How they rated their personal health 19What things they do to look after their health and wellbeing 21Things they would like to do but aren’t 22What things get in the way of looking after their own health 24

Experience of the GP Service 27How people rated their GP practice 28What factors motivate/trigger people to go to the GP 30What stops people going to the GP 33Are people open to the idea of a phone consultation before/ 37instead of an appointment

Improving GP service 40What makes a fantastic GP practice 42How to improve the GP service 48

Being involved in helping to improve the service 52Interest in helping to improve services 52How they might like to be involved in helping to improve 53the health services Final reflections from patients 61

In Conclusion 62

Contents

Brighton & Hove CCG and Healthwatch Brighton & Hove - Community Consultation

Parent/Carer Consultation Report - December 2014Brighton & Hove CCG and Healthwatch Brighton & Hove - Community Consultation

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Context

Kaizen were contracted to deliver community consultation and outreach in Brighton & Hove to be targeted at engaging some of the groups who have typically not been part of previous consultations. The main intention of the consultation was to increase the knowledge base in the area of Primary Care in order to impact strategy and practice and to raise awareness about opportunities for participation, engagement and involvement throughout Brighton & Hove. Brighton & Hove CCG and Healthwatch Brighton & Hove jointly funded this project.

Targets The targets for the consultation were:

• Consult with 750+ people in parts of Brighton & Hove where there hadn’t previously been much consultation both in terms of population groups and specific parts of the city. The neighbourhoods for consultation were initially identified as:• Portslade High Street • London Road shopping area• Housing area around Brighton station –

the area between Fleet Street and London Road.

• St Peters/North Laine• Elm Grove/ Lewes Road shops area • Norfolk Square

The areas were later expanded out to include other parts of Brighton but most of our time was spend in the above areas

• In terms of population it was agreed that we would consult with a diverse range of local people that represent the broad diversity of the area, and to largely consult with people aged between 18-50; to have approximately 2/3 of the consultation be with men; and with a particular focus on involving young people age 18-30 and members of the BME community

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AimsThere were a variety of drivers for this work, they included:• Desire to increase the understanding of barriers and motivators for people in how they relate to

their health services; to help ensure that policies and practise are led by a wide range of people’s experiences and not just the ‘usual suspects’

• To hear from those lesser-heard voices to shape future practices to improve care for patients.• To engage people into being open to continuing to be involved in helping to shape and improve

local health services • To create a positive experience of consultation for people who perhaps had not had their views

heard before• To ascertain and increase people’s awareness of Healthwatch B&H

Framing the research questionsBefore beginning any research project it is vital to identify and correctly frame the key research questions. This then allows the development of a research protocol that sets out how the methodology and data sources will achieve the research aims.

Typically we tend to frame research questions in 2 categories: primary and secondary research questions, as this gives scope to broaden the enquiry into areas of interest that would get ignored by focussing only on the primary questions, thereby maximising the research input. The primary questions link to the core purpose of the consultation, and the secondary questions are linked but represent a desire to capitalise on the opportunity of speaking to community members to ask other questions which are of interest but may not be core to the project needs.

In collaboration with the Brighton & Hove CCG (B&H CCG) and Healthwatch Brighton & Hove (HWB&H) project team we framed the research questions as follows:

Primary Questions

• What are the barriers to people going to the GP?

• What factors motivate people to go to the GP?

• What elements/factors make a fantastic GP Practice?

• What things do people do to look after their health (physical/mental)?

• What things get in the way (barriers/challenges) of looking after their own health?

• Engagement of people who would like to be involved on an ongoing basis to shape and improve services

Secondary Questions• How would they rate their GP practice

• What things could improve the practice for them?

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Parent/Carer Consultation Report - December 2014

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What we did

Phases of the Engagement and Research

The consultation was broken down into 3 phases as follows:

Phase 1 - Design and Development Phase: July-August

• Initial scoping and co-design meeting with the project partners to clarify the intentions and outcomes of the project

• Agreement of key aims and targets and the geographical area and demographics• Drafting, discussion and agreement on the key research scope and questions • Identification of particular sub-groups that may be harder to reach • Development of a coherent engagement narrative and structure for the engagement as a whole• Drafting and agreement of the interview questions and all survey instruments• Development of the consultation engagement plan • Maps of consultation area and contacts of organisations provided by B&H CCG and HWB&H• Agreement on communication and reporting approach and systems • Agreement on allocating the budget and the mix of methodologies • Kaizen team set up meeting

Phase 2 –Engagement and Consultation Phase: September-October

• Field test and refinement of the questionnaire • The consultation process was delivered using the agreed methodologies. This included a combination

of targeted outreach fielding questionnaires, depth interviews, street focus groups and a mini consultation with clinicians and community engagement specialists

• Everyone consulted with was offered a Healthwatch B&H flyer and where relevant, the option to be referred straight to HWB&H to discuss any serious concerns

• There was ongoing refinement and additions to the consultation process dependent on any changing needs and opportunities

• Regular monitoring of the process .

Phase 3 – Analysis and Reporting Phase: October-December

• Data analysed and key themes identified from Phase 2 research. Quantitative data was summarised and analysed. The qualitative data was hand coded, and thematic analysis drew out key themes

• A full project report written and submitted• A community report with high visual content prepared• Support Brighton and Hove CCG and Healthwatch B&H in looking at their internal systems for managing

and tracking engagement• Debrief meeting to discuss project

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Methodologies

In order to reach the widest range of community members and provide reliable data, we used a variety of methodologies with the emphasis being on high touch rather than high tech:

Targeted outreach• This was the primary method and included door-knocking, street engagement and having a presence

in the community at different times of day and on different days of the week

Pop-Up/Street Focus groups• This is a Kaizen developed methodology that takes the group discussion element of a traditional focus

group but delivers it in the community setting as a group discussion• For more information about street focus groups see this blog.

Clinician and Community Engagement Specialists’ Consultation• A limited consultation with clinicians and community engagement specialists ensured that

practitioners’ voices were also heard and included at this stage

Not all research questions were explored in all methodologies, but for critical areas we ensured multiple methods were used to make the data as rich and as robust as possible. The following table shows how different methodologies were used to address the various research questions.

PRIMARY RESEARCH QUESTIONS QU SFG C& CES

What are the barriers to people going to the GP? P P P

What factors motivate people to go to the GP? P P P

What elements/factors make a fantastic GP Practice? P P P

What things do people do to look after their health (physical/mental)? P P

What things get in the way (barriers/challenges) of looking after their own health? P P

Engagement of people who would like to hep ongoingly shape and improve services P P P

SECONDARY RESEARCH QUESTIONS QU SFG

How would they rate their GP practice? P

What things could improve the practice for them? P

QU: Questionnaire SGF: Street Focus Group C & CES: Clinicians and Community Engagement Specialists

http://wearekaizen.co.uk/blog/2013/08/kaizen-street-focus-group/

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Individual interviews

Individual interviews were carried out with 550 people. The questionnaire was semi-structured with mainly closed questions to give clear data, with some open questions and opportunities for people to add to the options presented or give more detail on their thoughts. The questionnaire took on average 15-20 minutes to complete and were conducted by 5 experienced Kaizen community engagers. The questionnaire was designed to be a conversational and relational process and the reporting from the engagers was that residents were happy to share their views and many said they found it an interesting conversation.

Interviews were carried out in different places, at different times (from 6am to 11.30pm) of the day and days of the week in order to make it more likely to include a wider range of people from the local area in the process.

Pop-Up / Street Focus Groups

213 people were engaged through 69 street focus groups in a wide variety of locations, (see below). The questions were open ended, giving respondents the opportunity to express their opinions about key areas of the consultation.

A wide variety of people were engaged via the street focus groups and this is a format that is particularly suited to engaging with people who do not normally take part in this sort of exercise.

Clinician and Community Engagement Specialists’ Consultation

Interviews were carried out with 8 clinician and community engagement specialists in order to add this different perspective to the consultation. Interviews were carried out using a conversational approach rather than a structured questionnaire format. The interviews took between 20-45 minutes.

The key questions posed were:

• What do you think are the challenges and barriers for people in looking after their own health?• What do you see are the barriers to people going to see their GP or surgery nurse?• What types of things cause/trigger people to access their health/GP services? • What things does your organisation currently do to encourage/support people to access health

services?• What elements make a fantastic GP practice?• What are the barriers to people being involved in local health services?• What things can be done to help engage a wider range of community members to be involved in

helping to improve local health services?• Have you heard of Healthwatch Brighton & Hove and do you know what their role is?

• If yes, what one thing would you like to suggest they prioritising working on?


Where we engaged people

We carried out street engagement as well as door knocking and consulted with people inside of shops and businesses. We stopped people on busy high streets, on estates, on quiet residential roads as well as speaking to people in shops, launderettes, super markets, corner shops and parks. We consulted with people in their local communities in everyday spaces that they frequent, such as pubs, take-away restaurants, newsagents and community halls and schools.

Below is a list of some of the spaces and places that we consulted in:

• High streets in Brighton and Portslade

• Supermarkets, Sainsbury’s and Aldi

• Independent and chain coffee shops, Costa Coffee

• St Peter’s church

• Market Stalls

• Businesses, i.e. 4Print and design Print Shop, Job Center, Phone repair shops

• YMCA, Kurdish Community Center

• Ladbrokes

• Pubs and Bars, i.e. Robin Hood Pub, Shuffle Bar

• Parks, i.e. The Level

• Brighton Train Station

• Schools, Libraries, Art galleries

• Shops, i.e. Vapping Vault, Holland & Barrett’s, Pottery shop, Scope Charity Shop

• Take away shops, i.e. Dominos

• Residential areas, i.e. Brunswick Square, Norfolk Square, Bear Road, Grove Hill

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About the Data

Limitations and reliability

There are a couple of factors that need to be taken into account when reflecting on the data from the consultation.

Firstly, while the sample size was fairly large, which gives a reasonable degree of reliability to the data and conclusions for the research as a whole, we need to be more cautious in giving too much weight to the stats from the smaller sub-groups as there is a wider margin of error in the data with the smaller populations.

Secondly, the sampling was entirely convenience sampling – meaning we engaged with the people we were able to make contact with (those who were at home when we answered and/or those who were happy to stop and carry out the questionnaire on the street).

Thirdly, it is important to note that we carried out the consultation with only 8 clinician and community engagement specialists, therefore we cannot assume that these views are representative of the views of professionals as a whole.

Finally, it is important to note that we are engagement specialists rather than health specialists and so have sought throughout to present the findings of the consultation rather than our interpretation on those findings. The only times where we have presented our interpretations and analysis is where the consultation areas were directly related to engagement where we have substantial expertise to bring to bear.

How we have presented the data

Unless otherwise stated all percentages are presented based on the % of people who answered that question, rather than as a % of everyone who took part in the consultation. With a couple of exceptions, the response rate for each question was consistently high and the only questions which had a lower response rate are the ones that were specifically about how people would like to stay involved where only those wanting ongoing involvement answered.

For the open questions and the street focus groups we performed thematic analysis, hand coding for themes that emerged using the principals and approach of Grounded Theory. The phrase ‘grounded theory’ refers to theory that is developed inductively from a body of data, rather than from the preconceptions of the researchers. Due to the nature of the sampling, a quantitative description of the qualitative data would be inappropriate. However, the frequency with which particular themes emerged is indicated by terms such as ‘all’, ‘most’, ‘many’, ‘some’, ‘a few’, or ‘one’.

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Key statistics

Who was engaged• 763 community members involved

• 550 individual interviews

• 69 pop-up focus groups with 213 people

General demographics• 93% live in the area• 82% were under age 45 (47% age 26-45)• 67% male, 33% female• 69% said their ethnicity was white British or white other• 83% identified as heterosexual/straight• 12% said they were disabled• 6% said they were carers• 60% said they worked full time (45%) or part time (15%); 24% were students and

14% unemployed• 88% said they have either not been consulted at all before (81%) or not much

before (7%)• 1% said they had been consulted a lot before, 2% said quite a bit• 19% said they were not registered at a GP (most of these people were under age

35, male and/or had been in the area less than a year)

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Attitudes to their health / rating of local GP services (1=v. poor, 10 =v. healthy)

• The average rating for their health was 7/10

• 74% say they believe very much that people have a responsibility to do their bit to improve their health and wellbeing

• 34% say they believe very much that patients have a responsibility to help improve their GP practice

• 72% say they almost never (38%) go to the GP or only go a couple of times a year

• 3% said they go every fortnight

• The average rating for their GP practice was 7/10

• Only 13% rated their practice less than 4/10

• 85% had not heard of Healthwatch before

Motivations and Barriers

• 58% said if they felt unwell for a few weeks it would motivate them to go to their GP, compared to 30% who said they would go right away if they felt unwell

• 46% said if they were called in for a check- up that would be a strong motivator

• 39% said if a family member or close friend encouraged them that would be a strong motivator

• 34% said difficulties in getting an appointment gets in the way for them going to see their GP

• 32% said lack of time gets in the way for them going to see their GP

• 21% said lack of trust of health professionals gets in the way for them going to see their GP

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Service Delivery

• 45% said they would be totally fine (35%) or OK with being offered a phone consultation, before or instead of, an appointment

• 25% said they would not at all be happy with being offered a phone consultation before or instead of an appointment

• Most critical aspects that create a fantastic GP practice

• 87% said easy to book appointments

• 86% said knowledgeable doctors and other staff

• 81% said reception staff being polite and welcoming

• 80% said friendly and personable staff and doctors

Helping to improve services

• 46% said they would either definitely (17%) or possibly (29%) like to find out more about how they can be involved in helping to improve health services in Brighton

• 20% said they could be interested in being part of an ongoing patients panel and 30% said they would be interested in this if it were an online panel

• 38% said they would like to put forward ideas for how services can be improved and 63% said they could give feedback (positive and negative)

• The biggest factor that would limit people being involved was time – said by 59%

• 8% said lack of trust of health professionals would be a barrier and 11% said thinking it wouldn’t make a difference would be a barrier


Who we consulted with

763 people were involved in the consultation. The following data concerns the 550 who completed individual interviews.

Connection to the area• 93% said they live in the area• 13% work in the area• 4% said they had other interest in the area

• A few people indicated that they are students in the area

Length of time having a connection to the area• 25% of people said they have been connected

to the area for 20 years or more• 19% said it has been less than 1 year, and 18%

said 1-3 years being connected to the area• 14% said they have been in the area for 10-20

years• 14% said 5-10 years• 10% said 3-5 years

Age• 35% of people said they are 25 years old or

younger• 24% of people said they are 26-45 years old

• 24% of people said are 26-35 years old• 23% said 36-45 years old

• 18% of people said they are 46 years or older• 8% said they are 46 to 55 years old• 8% said they are 56-65 years• 2% said they were 66 years and older

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Figure 1

Figure 2

Gender

• 67% of responses were male

• 33% of responses were female

• <1% said they preferred not to say

• The gender proportions for age groups remained mostly the same throughout the survey (more male to female)• People who are 66 years or older were

more often female than male (82% of 66 year olds and over were female)

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Ethnicities

The majority of those we spoke to self-identified as being White British, however we also spoke to a large number of people from a wide range of ethnic backgrounds, reflecting the diversity of the areas that we were consulting in; this included people who identified as:

The following table gives the breakdown by ethnicity, by percentage and by the actual number of people:

Ethnicity % Number

White: British 62.0% 334

White: Irish 1.1% 6

White; Gypsy or Irish Traveller 0.2% 1

White: Other White 7.4% 40

Mixed: White and Black Caribbean 1.1% 6

Mixed: White and Black African 1.5% 8

Mixed: White and Asian 1.9% 10

Mixed: Other Mixed 3.9% 21

Asian or Asian British: Indian 3.0% 16

Asian or Asian British: Pakistani 1.1% 6

Asian or Asian British: Bangladeshi 0.9% 5

Asian or Asian British: Other Asian 2.4% 13

Chinese 1.1% 6

Black or Black British: Caribbean 2.0% 11

Black or Black British: African 4.8% 26

Black or Black British: Other Black 1.3% 7

Arab 2.0% 11

Other Ethnic Group 1.5% 8

• Black British African and Caribbean• White other, including Irish, Spanish, Polish,

French, Italian, Latvian and Cypriot• British Asian, Indian, Pakistani, Bangladeshi, Sri-

Lankan, • Chinese

• Mixed heritage backgrounds, including White Caribbean and White African Arab

• South American, Brazilian • Other ethnic groups such as Turkish, Japanese,

Afghan, Iranian and Kurdish


Sexual Orientation• 83% of people said are were Heterosexual/

Straight• 8% said they are gay or lesbian

• 5% identified as gay men• 3% identified as lesbian/gay women

• 5% said identified as bisexual• 4% preferred not to say• 1% said Other

Disability• 12% of people said yes, they do consider

themselves to have a disability• <2% said they preferred not to say

Carers• 6% of people said they consider themselves to

be carers• 1% said they would rather not say

Work status • 45% of people said they currently work Full

Time• 15% said they work Part Time• 24% said they are Students• 14% said they are Not Currently in work• 4% of people are Retired• 1% said they would rather not say

How much their views have been consulted before• 81% said they had either never been consulted

with before • A further 16% said they have not been consulted

with much (7%) before or only a little (9%)• 1% said they had been consulted with a lot

before and 2% said quite a bit

NB. It is important to note that the phrasing of this question was general rather than specific to health consultation and so these are people who have largely not been involved in any consultation about their local area before

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Figure 3

How positive a place they think the area is to live

We asked a broad question asking them to rate the area overall as a place to live, on a scale from 1:10 where 1=terrible and 10=great. The majority clearly like living in Brighton and were positive about the area.

• The average rating people gave the area as a place to live was 8 out of 10

• 63% of people rated the area between 8 and 10 out of 10

• 29% of people rated it 8 out of 10

• 15% rated it 9 out of 10

• 19% rated it 10 out of 10

• 33% rated living in the area between 5 and 7 out of 10

• 18% said 7 out of 10



• Only 4% rated the area as between 1 and 4 out of 10

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Being Healthy

We asked a series of questions in both the individual interviews and the pop-up focus groups that had people explore their own individual health, looking at the following areas:• How they rate their current health• What things they do to look after their health (mental and physical)• What things they would like to do to look after their health, but are not currently• What things get in the way (barriers and challenges) of looking after their own health

As a starting point, we asked the following question about how much responsibility they felt that people have to look after their health and wellbeing.

How much do you agree that people have a responsibility to do their bit to improve their health and wellbeing (as opposed to believing it is mainly down to luck if you get sick or not)

• It is striking that 24% of people did not believe that people definitely have a responsibility to do their bit to improve their own health and wellbeing.

• 74% of people said they agreed Very Much So that they have a responsibility to do their bit• 21% said they agreed To Some Extent• 2% said they felt their responsibility was Not Much• 1% said Not At All and 1% said they Don’t Have an Opinion

When we divide people based on how healthy they say they are we can see an interesting variation, where 77% of very healthy people and 74% of quite healthy people say they agreed very much so with the statement, compared with only 53% of people who said they were not healthy.

How they rated their personal health

We asked people to rate their health on a scale of 1:10 where 1=very poor and 10=very healthy.

• The average rating people gave for their health was 7 out of 10• 42% of people rated their health between 8 and 10 out of 10

• 32% of the people rating it 8-10 are aged under 25• 26% of those who rated it 8 to 10 are between 26 and 35 years old• 22% of people who rated it 8-10 are between 36 and 45 years old

• 49% of people rated their health 5-7 • 9% of people rated their health 1-4 out of 10

• 28% of those who rated it 1-4 out of 10 are 36-46 years old

Using this question we are able to divide the people interviewed into 3 groups:• People who identify as very healthy – rating of 8:10/10• People who identify as quite healthy – rating of 5:7/10• People who identify as not healthy – rating 1:4/10


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By using these sub-groups in analysis interesting variations emerge and we will refer to this throughout the report.

Figure 4

As would be expected with a generally healthy group, most people did not go to their GP very often.

How often they have been going to the doctors• 38% of people said they Almost Never go to the doctors• 34% said they go to the doctors a Couple of Times a Year• 19% of people said they go Every Few Months• 7% said they go Monthly• 2% go Every Fortnight, and <1% said they go weekly

NB. Nearly 20% also told us that they were not actually registered at a GP surgery

How People Rated Their Health


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Figure 5

What things they do to look after their health and wellbeing

We asked this as an open question and split it into 2 parts – separating responses for physical and mental health. It is striking that while 97% of people were able to easily list things they do to look after their physical health, only 53% could easily list things they do to look after their mental health.

Physical Health

People highlighted activities and exercises that they did, as well as many people mentioning non-active things eating well, drinking fluids and spending time with people who are positive. Quite a few comments also mentioned things that they did not do, or had stopped doing such as giving up smoking and not eating food that was bad for them.

The most common physical activities mentioned were:• Going to the gym/doing exercise was mentioned in 33% of comments• Eating habits was very commonly mentioned – in 32% of comments

• Including things like changing diet, eating healthier food (and less unhealthy food), drinking or smoking less

• Walking (mentioned in 19% of comments)• Cycling (mentioned in 11% of comments)• Running/Jogging (mentioned in 10% of comments)

• Other sports, such as swimming, Football, skating, archery, martial arts, and climbing were also mentioned but less frequently

How Ofthen They Go to the Doctors


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Mental Health

People highlighted a range of different things that they did to look after their mental health and wellbeing:• Reading was the most commonly mentioned, by 16% of comments• Social support/activities such as being with friends were mentioned in 13% of the responses• Listening to music was also a popular mental health support mentioned, by 12% of the comments

• Some people commented on playing musical instruments • Meditation was mentioned by 11% of people• Being positive, motivated, relaxed and less stressed were also mentioned in several comments• Yoga, walking, climbing, and better eating habits, relaxation, resting, and working less were also listed

but less frequently• Less smoking and drinking, generally increasing healthy habits• Additional outlets were mentioned such as

• TV, art, gaming, and support groups• Exercise, football, sports, martial arts and running

These similar themes emerged in the street focus group conversations about what people do to maintain physical and mental health and wellbeing. Healthy eating and drinking water was the most commonly mentioned thing that people do to maintain health, followed by walking, cycling and going to the gym. Other things that weren’t mentioned in the individual interviews included getting enough sleep, staying away from people who are negative, listening to the doctor and following advice, smoking weed and volunteering.

Things they would like to do but aren’t

We all have things that we feel we “ought” to do more (or less) of, or would like to do more (or less) of. We asked this double question as it enabled analysis of the types of things that people know would be good for them and added an extra layer of depth to this question area. In particular, it is now possible to cross-analyse these responses with the comments around barriers and challenges which could be useful in developing social marketing or other campaigns to encourage people to do more of the things they know they should. For some people, increasing knowledge of what to do will be important, but for many it is clear that they have knowledge of what to do, but that there are things that are stopping them from getting into action.

Again, there was a very strong difference between the number of people who made comments under the physical health heading compared to the mental health heading, which for this question was 91% compared to 24%.

The most commonly listed things that people would like to do but aren’t in relation to their physical health was exercise more, reduce harmful activity (eating unhealthy food, smoking, drinking) and taking better care of themselves in terms of things like meditation, sleeping more and working less. In terms of mental health and wellbeing, yoga and meditation were frequently mentioned as was things like taking more time away from work, spending more time with friends and family, being less stressed and having a better work/life balance.

Very similar themes emerged in the street focus group discussions, where getting more exercise, stopping smoking and eating better were the top themes. Getting better sleep was also mentioned in just over 10% of conversations.

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“Learning more about how to take better care

of myself and improve my health and wellbeing.”

“More exercise, walk more. Tend to drive usually.”

“Need to sort out a GP.” “Would like to go back to

martial arts and gym.”

“Lose weight, try yoga and meditation.”

“Give up smoking is what I would love to do.”

“More exercise, walk more. Tend to drive usually.”

“Be around people and outside more.”

“Finding the time to be still.”

“Talk about things more – communicate.”

“Like to stop taking anti depressants.”

“Staying away from people who can make

me unhappy.”


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Barriers and challenges to maintaining health are very personal, and yet there are themes that emerge that again, could be helpful in identifying social marketing messaging. For example, time is the most commonly mentioned barrier, and so a campaign that addressed this and gave the message that there are lots of things you can do to improve your health that take very little time (eg. drink more water, park your car around the corner rather than outside your house, stand and pace when you make a phone call rather than sit down etc) could be effective.

• Time was by far the most commonly mentioned, being mentioned in 31% of comments

• People feel like they don’t have enough time or are too busy to get it all done

• The next most mentioned factor was money or the expense (mentioned in 18% of comments)

• 15% of people mentioned work (13% of comments) or school (2% of comments)

• 11% of comments mentioned laziness or lack of motivation

• 6% of people mentioned stress

• 6% mentioned smoking

• 5% of people mentioned family/child responsibilities

• 5% mentioned eating/drinking habits or choices

• 4% of comments mention social activities get in the way

• Other things mentioned were• Health, specific injuries, and age• Needing support / counselling• Hard to access the services• Feeling content with their health and

wellbeing

In the street focus groups, many similar themes emerged and were explored in more detail. In particular, cost was mentioned as a barrier – both in terms of cost of things like eating healthy food, and in terms of cost of activities such as gym membership. Another factor that was discussed in the group conversations was lack of will power to stick with commitments made to themselves and general laziness.

Figure 6

What things get in the way of looking after their own health

Main Factors Getting in the way of Their Health & Wellbeing

Lack of time Lack of interest

I don’t trust professionals / the people who make decisions

Lack of confidence

Don’t know what is possible

Attitude of professionals

Don’t think it would make any difference

Other


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“Time and finding a routine, I prioritize supporting other people and

forget to take care of myself.”

“Money, how society portrays having fun- i.e. drinking, the determined factors for what

food is available.”

“Easy to get unhealthy, lack of time.”

“Weak immune system, time- it’s difficult to fight

everything.”

“Too many long hours spent work no time for wellbeing.”

“Gym membership is too expensive, it’s difficult to meet new friends who don’t need the social activities or to be

around alcohol.”

“Anxiety and panic attacks. Lack of facilities.”

“Taking drugs and getting into trouble.”

“Work - it’s stressful and makes me want to smoke.”

“General complacency. Money for healthy

food.”

“Currently homeless.”

“Staying away from people who can make

me unhappy.”

“Good food too expensive.”


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The clinician and community engagement specialists’ views on this were as follows:

Top themes

• Patients too busy, multiple challenges, day to day life and struggling with young children / social housing and other day to day issues, powerless to change lifestyle 6/8

• Lack of access to good information and understanding of medical jargon 5/8

• Matter of money – some people on a low income 3/8

• Lack of education around own health and general education levels 3/8

• Health services not advertised enough to the public 2/8

• Lack of preventative and holistic agenda, GP’s only focus on one issue at a time 2/8

• Lack of Health Service supply 2/8

• Fear of what information is recorded against them on the system 2/8

• Surgery closures, too far to travel to new ones 2/8

• People who suffer from mental health issues don’t access services 2/8

• Patients not being heard 2/8

Other points

• Patients do not know which sources of information to trust

• People facing unemployment

• Lack of confidence in Health services

• Fear of being judged

• Difficult getting appointments and referrals

• Lack of permanent doctors / too many locums

• High reception staff turnover

• Men don’t access until they are in a crisis situation

• Young people prefer online services

• Personality traits and family systems

• Patients feeling patronised and intimidated

• Cultural beliefs

• English as a second language, lack of interpreters and expense of interpreters

“Don’t have time to go and because i don’t know my doctor to discuss personal issues with

and they don’t have time.”

“Social anxiety of going to the doctors, have severe

panic attacks.”

“Lost my skateboard and can’t afford a new one. Gym

too expensive.”

“Suffer from depression, got support from NHS”

“Talk about things more – communicate.”

“Smoking, work and studies- very busy.”

“It is not the patients that are hard to reach it is the Health Service that is hard to reach”

26


27


Experience of the GP Service

The 550 people who participated in individual interviews were registered at a very large variety of different GP practices:

Doctor/Surgeries They Are Registered At

Answer Options Response Percent Response Count

Albion Street Surgery 1.9% 10

Ardingly 1.3% 7

B+M Health & Wellbeing Centre 2.1% 11

Beaconsfield Medical Practice 0.2% 1

Benfield Valley 5.6% 30

Boots in Town Centre 0.9% 5

Bottom of Bear Rd. 9.3% 50

Brighton Station Health Centre 6.2% 33

Brighton Wellbeing Centre 1.7% 9

Broadway Surgery 3.6% 19

Brunswick Surgery 3.6% 19

Carden Avenue Surgery 1.7% 9

Central Hove Surgery 0.4% 2

Charter Medical Centre 1.1% 6

Church Surgery 1.3% 7

Coldeen Practice 0.7% 4

County Clinic 0.2% 1

Eastbourne 0.2% 1

Edward Street 0.2% 1

Enfield 0.4% 2

Foxhill Surgery 0.4% 2

Hacking 0.4% 2

Hassocks Health Centre 0.2% 1

Hove 7.1% 38

Hove Medical Centre 0.7% 4

Islingword 0.4% 2

Kempton/Kemptown 1.3% 7

Lewes Road 1.7% 9

Links Road 0.4% 2

London Road 0.4% 2

Longreach Ave 0.2% 1

Manor Practice 0.4% 2

Meadows (Burgess Hill) 0.4% 2

continued overleaf...

Mile Oak 0.2% 1

Morley St. 0.4% 2

Near Weston Rd. 0.6% 3

New Haven 0.2% 1

North Laine Medical Centre 0.2% 1

Oakwood Medical 0.2% 1

Old Steine 0.2% 1

Park Crescent 0.2% 1

Pavilion Surgery 0.4% 2

Portslade Clinic 1.5% 8

Preston Road 0.4% 2

Queens Park 0.2% 1

Regency Surgery 0.9% 5

Sackville Medical Centre 0.2% 1

Seven Dials Medical Centre 0.4% 2

Ship Street 0.2% 1

St Peters Medical (Oxford Rd) 0.2% 1

St. Andrews 0.6% 3

St. Ann 0.2% 1

Stanford 0.6% 3

Steine Surgery 1.3% 7

The Avenue 0.2% 1

The Practice Whitehawk Rd 0.2% 1

The Practice Willow House 1.7% 9

Thorne Rd 0.2% 1

Timworthery 0.6% 3

University 0.4% 2

Wooding Dean 2.8% 15

Not in Brighton 3.2% 17

Other 4.1% 22

Not Registered 18.7% 100

Don't Know 3.2% 17

answered question 535

Figure 7


28

Answer Options Response Percent Response Count


29


For this reason it is not sensible to break down the data by practice as the sample size is too small to be reliable. However, taken as a whole the responses do give a very valuable data snapshot of perceptions and feelings about the GP service. Of the 550 people doing individual interviews, 19% said they were not registered at the GP. This is a high number, and we understand it to be higher than the Brighton average for non-registered. The majority of people who were not registered were male, under 35 and/or had been in the area for less than one year. It is interesting to note that 11% of people who rated their overall health as poor were not registered with a GP.

The following question areas were explored:• How would they rate their GP practice?• What factors motivate/trigger people to go to

their GP?• What are the barriers to people going to the

GP?• Are people open to the idea of a phone

consultation before or instead of face to face• What elements/factors make a fantastic GP

practice?

We also asked questions around what factors make a fantastic GP practice and what things could be done to improve their GP practice but this will be dealt with in the next section.

How people rated their GP practice

We asked people to give an overall rating from 1:10 where 1=terrible and 10=amazing

• The average of the ratings given by all people for their local GP was 7 out of 10

• 49% rated their local GP practice between 8 and 10• 19% of people said 8, 14% said 9, 16% said

10• 38% of people rated it between 5 to 7 out of

10• 13% rated it between 1 and 4 out of 10


30


Figure 8

Figure 9

How People Rate Their GP Practice

30


31


The less healthy someone feels, the lower they rate the GP Practice, perhaps due to association with illness and having had more negative experiences.

• The average rating by the very healthy group was 7.37• The average rating by the quite healthy group was 7.04• The average rating by the not healthy group was 6.74

What factors motivate/trigger people to go to the GP

While at one level feeling ill is an obvious motivator/trigger to go the GP, in fact the picture is much more complex and there are clearly many factors that influence the choice to go seek medical help from the GP.

We asked this question in a semi-structured format (with both closed options and an open section) in the individual questionnaire and as an open question in the street focus groups.

In the structured part we asked people to rate how big a motivator a series of factors/influences would be on their decision to go to the GP. The following charts show first the average ratings and a breakdown for each of the option choices. The rating scale went from 1:5, where 1=not very motivating and 5=very motivating.

Figure 10


32



Top themes• People who are very sick, frightened or worried about their health 4/8• Friendly, open, approachable and welcoming GP Practices with good atmosphere and

communication 4/8

Other

• Minor illnesses

• People who are aware of their own health needs

• Good relationship with same GP and treated well

• Patients knowing they have the power to change their GP if they are unhappy

• Not labelling people as drinker / smoker / overweight – not being prejudiced

• High quality staff and GP’s

• Good rapport

• Ease of booking an appointment

• Suitable services and good referral and signposting systems

• No alternatives, don not know where else to go

• Need for GP letter and or sick notes for school absences and benefits.

• Public not buying in to current medical model

• If people cannot self manage their health issues alone

• Need for tests such as blood test / biopsy

How People Ranked Their Motivation To See Their GP

Feeling unwell – go right away

Feeling unwell – after a few weeks

Feeling depressed

My husband/wife/partner/friend/child encourages me

Get a letter calling me in for a check-up

Feeling concerned after doing some internet research

Other

Figure 11

32


33


34


What stops people going to the GP

As with motivating factors, barriers are highly personal – what stops one person will not stop another; and yet there are clear themes and barriers that are common factors for many different types of people.

As with the motivators, we asked this question in a semi-structured format (with both closed options and an open section) in the individual questionnaire and as an open question in the street focus groups.

• The top barrier said by 34% of people was that it was hard to be able to get an appointment

• 32% of people said they don’t have time (due to work/caring/parenting etc)

• 21% said they don’t really trust health professionals that much

• 20% said they never get to see the same doctor

• 15% said they are scared they might get bad news

• 15% said the GP surgery isn’t open when they would be able to go (time/day of the week)• 32% of these responses are 25 years old or younger

• 12% said they don’t like going to the Doctor’s• 30% of these responses were 25 years or younger

• 12% said the GP is far away from them and travel is difficult• 33% of these responses were 25 or under

• 38% of people listed other reasons or comments as to what gets in their way

• Quite a few people stated nothing got in their way from seeing their GP

• Some responses indicated they would only go in if there was a serious need

• Some of the people don’t want to bother the doctors or take away the services from others who need them more

• A few people mentioned they don’t get sick enough to need to go in

• Some prefer to wait it out, or self treat in other ways

• The atmosphere/surroundings were mentioned by some people

• Some people didn’t like the interactions they had with the doctors/receptionists

• Some people felt misunderstood or treated badly

• Feeling unimportant or not heard by doctors was mentioned

• Feeling uncomfortable or lack of privacy

34


35


• Some people stated other barriers that prevented them• Physical incapability

• Being too sick to make it in

• Not being able to afford it or not being registered

• Being unable to get appointments or see a doctor when they need

• Appointment getting and wait times were often mentioned

• Lack of alternative options or not liking the options they are given

• Laziness

• People who said they don’t like going to the doctors sometimes gave further reasons:• It taking too long was often listed:

• To get appointment• To see a doctor once at the GP Practice

• Not being listened to or respected• General dislike of hospitals/medical environment• Bad experiences in the past

Figure 12

In the street focus groups the most frequently discussed themes were around difficulties in getting appointments, fear/lack of confidence, laziness, lack of time and the location of GP being far away from where they lived and cost.

Things That Get in the Way of Them Going to See the GP

Scared I might get bad news eg cancer or another serious disease

I never get to see the same doctor

I don’t like going to the Doctors

The GP is far away from me and travel is difficult

The GP surgery isn’t open when I would be able to go

Hard to be able to get an appointment

I don’t have time (due to work, caring/parenting res-ponsibilities etc)

I don’t really trust health pro-fessionals that much

Other (please say)


36


As can be seen from Figure 13 below there is quite interesting variation by sub group. For example, when we look at how healthy people say they are, one example of significant variation concerns lack of trust in health professionals:

• 17% of people who are very healthy said lack of trust gets in the way of them going to see the GP• 19% of people who are quite healthy said lack of trust was a barrier for them• 39% of people who are not healthy said lack of trust was a barrier for them

People with poor health were also much more likely than those in better health to say that not getting to see the same doctor, distance to the surgery and inconvenient opening times are important barriers.

There was also variation between men and women, for example:

• 18% of men are more likely to avoid going to the GP for fear of getting bad news as compared to 9% of women

• Being able to see the same doctor is more important to women (26%) as compared to 17% of men

• 44% of women said finding it hard to get an appointment puts them off going to the GP as compared to 29% of men

What gets in the way of going to see the GP A

ll

Mal

e

Fem

ale

>Age 25 A

ge

26-4

5

Regi

s-te

red

Not

Re

gis-

tere

d

Not

H

ealt

hy

Qui

te

Hea

lthy

Very

H

ealt

hy

Scared I might get bad news 15% 18% 9% 12% 18% 16% 14% 20% 16% 12%

I never get to see the same Doctor 20% 17% 26% 12% 22% 23% 5% 30% 19% 18%

I don’t like going to Doctors 12% 12% 14% 10% 14% 12% 13% 18% 13% 12%

The GP is far away from me and travel is difficult 12% 10% 15% 11% 9% 12% 10% 23% 12% 10%

The GP surgery isn’t open when I would be

able to go15% 13% 18% 13% 14% 16% 8% 23% 12% 17%

Hard to get an appointment 34% 29% 44% 34% 29% 37% 24% 36% 30% 38%

I don’t have time 32% 30% 39% 32% 30% 34% 28% 23% 33% 34%

I don’t really trust health professionals

that much21% 20% 22% 12% 25% 22% 16% 39% 19% 17%

Figure 13

36


37


“Not friendly, so don’t trust them. Have to wait

a long time, no water dispenser.”

“Drop-in appointment system can be tricky.”

“Have to call really early in the mornings.”

“Aware of time constraints on NHS, Don’t want to waste

their time.”

“Not enough time when you get here.”

“I don’t want to waste their time and quite often things get better

on their own.”

“Too time consuming, too many queues and too inefficient.”

“Only go if I really need to- I’m a typical man.”

“Had too many bad experiences of

discrimination.”

“They don’t take me seriously.”

“Makes me feel really uncomfortable, I would

only go if I thought it really works.”

“Have a slight aversion to being around authority figures,

rude receptionists.”“Physically couldn’t get there.”

“Having to explain myself to different doctors. Don’t trust health professionals: not for

depression.”

“I don’t trust them for confidentiality so if I don’t want my family to know I won’t go.”



Top themes• Access to appointments – systems are confusing 6/8

• No extended hours of opening in some surgeries 2/8

• Fear of what is recorded against them on system 2/8

• Attitude of reception staff 2/8

• Patients offended by the way the GP’s have treated them 2/8

• GP’s are too busy to see patients for preventative matters 2/8

• People are not aware of their own health 2/8

Other• Primary care have too much workload

• Patients who speak English as a second language

• GP vacancies are not filled

• People like to see the same GP

• Fear of own health and finding out what is wrong

• People moving around, not staying in the same place for long

• Immigration – people do not have the correct paperwork

• Lack of trust in Health Services

• People do not want to waste GP time due to national pressure

• GP’s don’t care about patients voices

Are people open to the idea of a phone consultation before/ instead of an appointment

Channel shift to phone consultations has the potential to free up GP surgery time as well as deal with some of the barriers to do with time and travel.

• 45% of people said they would be either totally fine (35%) or OK (10%) with this

• 19% said It Depends

• 36% of people said they would either be not very happy (11%) or not at all happy (25%) with this

38

‘People would rather go to Accident and

Emergency and Children’s Hospitals

than go and see their GP.’

38


Figure 14

How they would feel about being offered a phone consultation before or instead of an appointment

How they feel about being

offered phone consultation

All

Mal

e

Fem

ale

> 25

Age

26

-45

Regi

s-te

red

Not

Re

gis-

tere

d

Not

Hea

lthy

Qui

te

Hea

lthy

Very

H

ealt

hy

Totally Fine 35% 32% 41% 33% 31% 36% 28% 30% 31% 41%

OK 10% 10% 10% 14% 9% 10% 9% 11% 11% 9%

It Depends 19% 19% 21% 19% 22% 20% 15% 17% 20% 19%

Not Very Happy 11% 10% 12% 9% 8% 11% 11% 6% 11% 12%

Not At All Happy 25% 29% 17% 25% 30% 23% 37% 36% 26% 19%

Figure 15

39


There are a number of interesting variations in response by different sub group. People who are happier with the idea of being offered a phone consultation tend to be female and say they are very healthy:

• 41% of females would feel totally fine compared with 32% of males

• 29% of males would not be happy at all compared with 17% of females

• 36% of people who say they are not healthy would not be happy at all compared with 19% of people who say they are healthy

40

40


41


Improving GP service

Service improvement is the central driver behind this entire consultation, with the premise that by better understanding patient perspectives and needs, service improvement can be made.

As an entry into the question of what can be done to improve the GP service, we asked a question that explored whether patients feel that it is their responsibility to help improve the service. We asked the following question:

How much do you agree that patients have a responsibility to help improve their local GP practice [as opposed to believing it is mainly the responsibility of the Health Service]

• 77% said that they agreed with that statement either very much so (34%) or to some extent (43%)• 10% said not much, and 10% said not at all• 3% said they don’t have an opinion

Looking at Figure 17 we can see some further detail according to sub-group:

• People who agree very much so are more likely to say they are very healthy (37%)• 21% of people who say they are not healthy agree very much so• People who are not registered are more likely to not have an opinion (8%) compared with people who

are registered (2%)

Figure 16


42


• How much do you agree that patients have a responsibility to help improve their local GP practice [as opposed to believing it is mainly the responsibility of the Health Service]

Do you agree patients have a

responsibility to improve local GP

practice

All

Mal

e

Fem

ale

> 25

Age

26

-45

Regi

s-te

red

Not

Re

gis-

tere

d

Not

H

ealt

hy

Qui

te

Hea

lthy

Very

H

ealt

hy

Very Much So 34% 34% 35% 32% 34% 35% 32% 21% 35% 37%

To Some Extent 43% 42% 45% 43% 44% 43% 40% 47% 42% 43%

Not Much 10% 9% 11% 10% 8% 10% 11% 13% 11% 8%

Not At All 10% 11% 7% 9% 12% 10% 9% 15% 9% 9%

Don’t Have An Opinion 3% 4% 2% 5% 2% 2% 8% 4% 3% 3%

Figure 17

In general, responses across the sub-groups were similar with a few variations highlighted below:

• 37% of very healthy people as compared to 21% of not healthy people say Very much So • 15% of not healthy people compared to 9% of very healthy people say Not At All• 11% of males compared to 7% of females say Not At All• People who are not registered are more likely to not have an opinion (8%) compared with people

who are registered (2%)

The 2 key questions we asked in terms of driving service improvement were:

• What elements/factors make a fantastic GP practice?• What things could improve the practice for them?

42


43


What makes a fantastic GP practice

In the individual interviews we explored this question first as a fully open question, and then as a semi-structured question. The data is from the second part of the exploration where we offered up a range of factors and asked people to rate how important they are in creating a fantastic GP practice. The rating scale went from 1:5 where 1=not important and 5=critical.

• Reception staff being polite and welcoming has an average importance rating of 4 out of 5• 60% of people rated the importance of this as 5 out of 5• 21% of responses rated it 4 out of 5

• Easy to book appointments when you need them was ranked with an average importance of 5 out of 5• 69% of responses ranked this at critical importance (5 out of 5)• 18% rated the importance of this as 4

• Being able to see a GP or Nurse at a time that is convenient had an average rating of 4 out of 5• 47% of people rated the importance of this as 5 out of 5• 27% of people rated it 4 out of 5

• An attractive building was given an average importance ranking of 2 out of 5

• Being able to speak to a GP or nurse on the phone for advice had an average rating of 3 out of 5• 26% of people felt the importance of this was 5 out of 5• 20% rated the importance as 4 out of 5

• Knowledgeable doctors and staff was given an average ranking of 5 out of 5• 66% of people rated the importance of this as 5 out of 5• 20% of people rated it as 4 out of 5

• Easy to reach by public transport / close enough to walk to was rated on average as 4 out of 5• 42% of responses rated this as 5 out of 5• 22% rated it 4 of 5

• Friendly and personable staff and doctors was on average rated with importance of 4 out of 5• 58% of people gave this an importance of 5 out of 5• 22% of responses rated it as 4 out of 5

• Appointments happen more or less on time has an average rating of 4 out of 5• 47% of responses gave this an importance of 5 out of 5• 25% of people rated it 4 out of 5

• Support for things which might be non-medical (eg help with benefits, accessing housing services) has an average rating of 2 out of 5• 20% said 2 out of 5• 39% said 1 out of 5

• Information and suggestions about other health related services beyond the GP Practice was rated at 3 out of 5


44


Figure 18

Figure 19

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Aspects Rated on 1:5 Scale (1 is not important and 5 is critical)

Aver

age

Ratin

g Re

ceiv

ed

% o

f Rat

ing

Rece

ived

for E

ach

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44


45


How they rate the following aspects in terms of importance in creating a fantastic GP Practice (% of responses rating it 4 or 5 out of a 1-5 scale where 1 is not important, 5 is critical)

How they rate these aspects in terms of importance to a fantastic GP Practice

All

Mal

e

Fem

ale

Und

er

25 Age

26

-45

Regi

s-te

red

Not

Re

gis-

tere

d

Not

Hea

lthy

Qui

te

Hea

lthy

Very

H

ealt

hy

Reception staff being polite and welcoming 81% 78% 87% 78% 81% 82% 76% 79% 82% 80%

Easy to book appointments when you need them 87% 86% 88% 88% 87% 87% 85% 81% 88% 86%

Being able to see a GP or nurse at a time that is convenient to you

74% 74% 72% 74% 75% 75% 71% 73% 73% 74%

An attractive building 21% 23% 19% 18% 21% 21% 19% 15% 23% 21%

Being able to speak to a GP or nurse on the phone for advice

46% 44% 51% 45% 47% 46% 44% 42% 45% 48%

Knowledgeable doctors and other staff 86% 87% 84% 87% 88% 86% 84% 85% 85% 87%

Easy to reach by public transport / close enough to walk to

63% 63% 63% 60% 65% 66% 52% 55% 67% 63%

Friendly and personable staff and doctors 80% 80% 80% 82% 80% 81% 75% 76% 81% 79%

Appointments happen more or less on time 72% 73% 72% 79% 68% 72% 72% 74% 75% 69%

Support for things which might be non medical e.g. help with benefits, accessing housing advice etc

23% 23% 20% 21% 24% 25% 14% 26% 24% 20%

Information and suggestions about other health related services beyond the GP Practice

48% 47% 50% 52% 49% 48% 51% 49% 46% 49%

Figure 20


46


Figure 20 gives us the opportunity to look at the responses in more detail, broken down by sub-group:

In general, responses across the sub-groups were aligned to similar priorities with a few variations highlighted below:

• 87% of females feel that reception staff being polite and welcoming is important, compared with 78% of males

• It is more important to people aged 25 years and under that appointments happen more or less on time (79%) compared with those aged 26 years and above (68%)

• An attractive building is least important to people who say they are not healthy (15%) compared with all other sub-groups

• People are more likely to find additional non-medical support services important when they are registered with a GP (25%) rather than not registered (14%)

In the open discussions and street focus groups, strong themes emerged.

• Most commonly people mentioned appointments as a key factor• A lot of people said having more available

appointments• Easier access to appointments

• Easier to call in for appointments• Better call answering, even after

appointment is set• Booking them sooner

• Some people said same day appointments

• More options for booking• Online, in person, calling

• Getting them ahead of time (vs. having to call in day of )

• Wanting more time for appointments• Not being rushed or left feeling they didn’t

get the right care in time given• More time with their doctor

• Being available at later hours or all the time

• Having doctors and staff be friendly was also a strong theme

• Passionate, welcoming, approachable staff

• Being listened to was mentioned a lot• Receptionists shouldn’t be rude or

inconsiderate

“One that is open, available, flexible. High quality nurses and

doctors, more magazines.”

“Having more female doctors for women’s’ issues. Doctors that have time for you as a

person.”

“Ease of appointments, not feeling too rushed, range of

services.”

“Seen on time, a second opinion available.”

“More care and attention for mental health.”

46


47


• Not feeling patronised or not respected

• Not feeling rushed and uncared for by doctors

• More personal care• Having better relationships with

their doctors• Feeling cared for, supported• Seeing the same doctors• Less business-like

• Some people mentioned the doctors should be more knowledgeable• Some said doctors being aware of their

personal medical history• Better listening to patients about symptoms

and history

• Short wait times to see doctor once there was mentioned by some people

• More comfortable environments• Feeling safe, at ease• Good atmosphere such as music, reading,

activities, tea, etc• Clean

• Good advice and follow ups was also mentioned as being important• Clear communication and explanations• Explaining diagnosis and prescriptions • Follow up calls/appointments• Advice for additional or alternative health

options and services

Given the importance of this question we have allowed more space for the voices of patients to come through rather than only summarising them:

“Generally experience that doctors don’t take my issues

seriously and don’t really listen to me. Treat you as a person not a number, don’t rush you. Take me

seriously and run tests, don’t make assumptions and dismiss me.”

“Patient able to give an opinion feedback.”

“Friendly and approachable, having a good and clear and

useful website.”

“Walk in appointments, longer opening hours and weekends

(it’s difficult when you are working).”

“Good communicative doctor, welcoming staff, doctor who listens, ability to communicate electronically. eg. both

appointments and repeat prescriptions.”

“Better appointment system, too long to wait.”


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“Empathy, time to talk to doctor, not rush you, have same surgery and be

able to keep relationship.” “Having a high enough staff to patient ratio, Being able to do things like blood tests there.”

“GP’s who have faith in the system, as my GP told me the whole system is a shambles.”” “A doctor who really listens, not

assessed by a receptionist who thinks he/she knows better.”

“Waiting tunes, deliver news in a more positive way and make eye

contact.”

“Get appointments when I want them, feel I’m listened to and there is enough time” “Easy to get an

appointment, friendly, Send me a text

reminder.”

“Reception staff are friendly- first point of contact is really important. Doctors

that really listen.”“Welcoming front desk, somewhere

confidential to talk (at reception) short telephone wait times, get an appointment quicker. Also offer complementary and

alternative approaches to health.” “Friendly, easily accessible and not intimidating.”

“Friendly, clear, water dispenser, efficient staff.

Same doctor for follow up.”

“Getting an appointment when you actually need one - not 2 weeks later.

Listen to the patient and get to the root cause, don’t over medicate.”

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Top themes

• Patients treated as individuals who are respected through building trust and positive relationships and are friendly 5/8

• Practices that focus on preventative and holistic health 3/8

• Full quota of GP’s / filled GP vacancies and good recruitment of GP’s 3/8

• Good communication 2/8

Other• Practices that work with the voluntary sector• Available appointments• GP’s willingness to refer patients• Flexibility• Getting the basics right• Funding • Nice environment / building with good facilities• Access to other support such as money, housing

advice etc.• Classes and activities for healthy living for

patients• Education for patients on health delivered in the

community• Staff and GP’s with good people skills• Good technical systems• Transparency• Community focus with the ability to understand

the community they are based in• Good business model• Have access to good information• Not having structural and financial issues• Continuity of care• Consistency• High standards of care

“More appointments outside of working hours for working

people.”

“Warm atmosphere, positive space – be honest if doctor doesn’t know the answer.”

“More supportive environment for sensitive questions.”

“Same some appointment space for emergencies.”

“More holistic and alternative therapies.”

“Mental health - dedicated GP, more emotional intelligence.”

How to improve the GP serviceThe same key themes as above came up but there were also a lot of specific suggestions. Again we are wanting to present the patient voice on this rather than overly summarising. 367 people made comments and suggestions on this question.


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“Getting

an appointment when you actually need one - not 2 weeks later. Listen to the patient and get to the root

cause, don’t over medicate.”“Raising more awareness

(information giving) about things like nutrition and staying healthy,

Appointments more on time.”

“Advice about things like

managing stress, other things other than medicine.”

“Communication between pharmacy

and doctor, different elements of one

service”

“Street parking very expensive, important appointments

happening on time.”

“A more personable service, more considerate to

everyone.”

“More time for patients.

Short appointment

was too rushed, which then caused wrong info

to be passed on and

that caused problems

later.”

“Dr’s. with more knowledge about anti-depressants.”

“Communication between

pharmacy and doctor, different elements of one

service”

“More understanding with homeless

people.”

“Improve waiting

times, better understanding

of mental health.”

“More time to each person.

Making you feel like

they are not dismissing you. Time.”

“If they offered alternatives to medication.”

“Good referrals for other health services; currently have to really push your case to get one. Feels like they

are trying to save and budget.”“Having second named doctor so

when your primary doctor is not there - so

they know you.”

“Reception staff are appallingly

rude and judgemental.”

“Reception staff - crucial that they are not bitchy. Not to embarrass your

sensitivity, need to be natural - genuine. Common sense.”

“More doctors, more appointments, doctor open 7 days a week.”

“Get rid of ringing in the morning for appointment.”

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“For me to see the same doctor and for

the doctor to know my history.”

“More clarity with drug use

and why given, side effects.”

“They should follow things up - I shouldn’t have to chase them. Take my medical problems seriously and not over-medicate me.”

“Water dispenser and better time keeping and more doctors.”

“News magazines in the waiting room. Having a hot water machine for tea/

coffee (or access to tea).”

“Phone consultation, pass on to nurse. GP service needs to

be re-thought.”“News magazines in the waiting room. Having a hot water machine for tea/

coffee (or access to tea).”

“If a doctor was available by email. Waiting room music is

off putting.”

“Sometimes it’s required that you share your symptom with reception to get an appointment or they won’t classify it as an emergency. But don’t always want to share it with them - it’s private info that

only Docs need to know.”

“When the doctor doesn’t give me enough

information about a prescription, I have decided not to fill it

because I don’t know enough about what it

does.”

“More staff in the morning to answer the phone so you can book

an appointment.”

“Feeling welcomed, safe and respected

(not feeling judged).”

“The ease of booking an appointment, to book ahead would make it easier to schedule around

work.”

“Really listen to me and refer for counselling, treat

people as individuals - don’t fit me into a

box.”

“More welcoming staff, can feel the doctors are rushed off their feet.”

“Good reception staff, polite and welcoming, nice

environment, sympathetic doctor with good listening

and respect.”


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Being involved in helping to improve the service

It is one thing for someone to say they think that patients share responsibility to help improve services, and another to say that they themselves are up for taking some responsibility and actually helping. And yet, many people did say they were interested in finding out more about how they could help, and large numbers gave their contact details to enable this to happen.

We asked several questions which were aimed at exploring this:

• Would they like to find out more about how they could be involved in helping to improve health services in Brighton?

• How might they like to be involved?

• What could get in the way and stop them from being involved in helping to improve health services in Brighton

Interest in helping to improve services

• 46% of people interviewed (242 people) said they had interest in finding out more about being involved in helping to improve health services in Brighton.• 17% said Yes Definitely, they would like to find out more about getting involved

• 29% of people said Yes Possibly they would like to find out more

• 50% of the people who rated their local GP between 8 and 10 said yes definitely or yes possibly to finding out more about getting involved

• 55% of people said No Thanks

• The actual numbers of people who are potentially interested in future involvement in helping to improve health services are quite impressive and are indicative of not only the focus on engagement in the consultation, but also the fact that when engaged with at sufficient depth, people are interested in the issues and want to make a difference:• 90 people said they would definitely like to find out more about how they could be involved

• 152 people said they would possibly like to find out more about how they could be involved

• This represents a very sizeable opportunity but it will require significant planning and resource to capitalise on it .

• It is clear that a wide range of opportunities for involvement will need to be created as a one-size-fits all approach will not engage most people.

There are many people who question whether there is interest from the non-usual suspects in getting involved in this type of activity. These fairly high numbers show that the belief that people are not interested is not actually correct and give reason to be optimistic that it is possible to get a much wider range of people engaged in sharing their views if sufficient effort is made to engage and include them.


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Given the remit of Healthwatch as the consumer champion for improving the health sector, it is striking that 85% said they had never heard of it. Of the remaining 15%, only about half said they definitely had heard of it, as opposed to possibly knowing about the organisation. Clearly there is more work to be done to raise awareness of the organisations’ role.

Figure 21

How they might like to be involved in helping to improve the health services

• 50% of people who took the survey responded to this question and so the statistics here relate to the % of people who answered this question rather than the total survey population

• 63% of people said they might like to be involved through giving feedback (positive or negative)• 35% of the respondents are 25 years or younger

• 38% of people said they might like to be involved by putting forward ideas for how things could be improved• 36% of the respondents are 25 or under

• 30% said by being part of an online panel / group• 37% are 25 or younger

• 29% of them said by being invited to discussions on particular conditions/services• 32% of them are between 36 and 45 years

Have They Ever Heard of Healthwatch

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• 26% of people who responded said by getting a newsletter or other information

• 20% said by being part of a patients’ panel to work with the GP practices in an ongoing basis• 35% of these responses are aged between 26 and 35 years

• 20% of them said by being involved in strategic decision making• 33% of them are between 26 and 35 years old

Figure 22

How They Might Like to Be Involved in Helping to Improve Health Services

By being invited to discussions on particular conditions/services

By being involved in strategic decision making

By putting forward ideas for how things could be improved

By being part of an online panel / group

By being part of a patients’ panel to work with the GP practices in an ongoing basis

By getting a newsletter or other information

By giving feedback (positive or negative)

Other (please say)


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How they might like to be involved in helping to improve the health services

How they’d like to be involved in improving health services

All

Mal

e

Fem

ale

Und

er

25 Age

26

-45

Regi

s-te

red

Not

Re

gis-

tere

d

Not

H

ealt

hy

Qui

te

Hea

lthy

Very

H

ealt

hy

By being invited to discussions on particular conditions/services

29% 31% 24% 17% 37% 32% 16% 36% 28% 28%

By being involved in strategic decision making

20% 20% 18% 13% 25% 21% 13% 36% 18% 19%

By putting forward ideas for how things could be improved

38% 38% 39% 42% 39% 38% 40% 40% 40% 37%

By being part of an online panel / group 30% 29% 32% 34% 28% 32% 22% 52% 31% 25%

By being part of a patients’ panel to work with the GP practices in an ongoing basis

20% 20% 22% 7% 26% 23% 9% 24% 18% 23%

By getting a newsletter or other information 26% 26% 28% 25% 26% 28% 22% 28% 24% 30%

By getting a newsletter or other information 63% 65% 59% 69% 68% 62% 69% 84% 60% 63%

Figure 23

What could stop them from being involved in helping to improve local health services

For this question we gave an option list of potential barriers as well as an open section for people to add additional barriers/challenges. Knowledge of potential barriers will enable the CCG to design the involvement opportunities in ways that mitigate or minimise the challenges which will enable more people to be involved.

• 59% of people said lack of time: this was by far the top barrier • 31% said lack of interest• 12% said they don’t know what is possible

• 39% of people who said this are between 26 and 35 years old

• 11% said they don’t think it would make a difference• 8% said attitude of professionals

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• 8% said lack of confidence• 43% of this group are aged 25 or younger

• 7% said they don’t trust professionals / the people who make decisions• 49% of this group are people between the ages of 36 and 45 years

• 18% said other reasons• Time was mentioned quite a few times

• People mentioned that the services don’t have enough time for them• Other priorities that consume time

• Some people mentioned negative feelings• Feeling uncared for by doctors/GP• They feel it might be a waste of time or not meaningful• Disliking the system

• Other factors which would be barriers to involvement included:• Lack of interest or motivation• Lack of confidence• Not having experience or knowledge to share

• Feeling they have nothing to give• Don’t use the system / medicine

• Health or age issues preventing them• Not trusting sharing details (eg getting scammed)

Figure 24


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“Spent a lot of time in hospitals in my childhood,

don’t want to go back there.”

“Have had really negative experiences, so it would be

uncomfortable.”

“Money to get there.”

“Already do 60 hours+ per week at Salvation Army.”

“I already am involved, through my community work.”

“Don’t trust confidentiality, will market and sell my details.”

“Not of interest as don’t have enough opinions.”

“Waste of time, doctors don’t care about me.”

“Don’t feel my voice would be heard.”

“Not being organized, travel cost, personal issues.”

“I’m not a regular enough user so don’t feel I have

anything to offer.”

“I’m not a regular enough user so don’t feel I have

anything to offer.”

“Not feeling qualified to make the decision.”

“Bad experience of the NHS team - but loves his GP.”

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59


What could stop them from being involved in helping to improve local health services

Barriers preventing them from being involved in helping improve health services.

All

Mal

e

Fem

ale

> 25

Age

26

-45

Regi

s-te

red

Not

Re

gis-

tere

d

Not

H

ealt

hy

Qui

te

Hea

lthy

Very

H

ealt

hy

Lack of time 59% 56% 64% 59% 59% 59% 58% 42% 58% 65%

Lack of interest 31% 34% 25% 39% 29% 29% 37% 42% 33% 25%

I don’t trust professionals / the people who make decisions

7% 7% 7% 4% 10% 8% 3% 16% 7% 5%

Lack of confidence 8% 7% 9% 9% 6% 9% 3% 9% 9% 6%

Don’t know what is possible 12% 12% 12% 11% 14% 12% 13% 12% 13% 10%

Attitude of professionals 8% 9% 7% 5% 9% 8% 8% 12% 9% 6%

Don’t think it would make any difference 11% 11% 9% 10% 14% 13% 3% 23% 9% 11%

Figure 25


Top themes

• NHS structure not set up to involve people and is too complicated for patient participation 5/8• Lack of follow up / implementation so can’t be bothered anymore and people become tired of being

asked same questions 3/8• Difficult to get new people involved, always same people mostly ones who need/ depend and use

the services regularly 3/8• Fear of being outspoken may lead to patients being struck off surgery patient list 2/8• Confidence and self-esteem issues 2/8• Opportunities are not advertised or promoted enough 2/8


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Other• People who are well do not see it as a priority

• People just do not want to and are not interested

• People have to many other things to deal with that are a priority for them

• Not a common thing to give feedback after a GP appointment culturally as people would after a meal or trip

• People are put off if it is done badly

• Lack of good feedback models

• Lack of long term relationships, too many one offs

• Local services are not willing to involve patients

• Hospital culture is one of not owning up to mistakes as the whistle blowing culture is not present

‘GP’s are a small business, GP’s receive money for their business and do not see themselves as part of the community and this is not changing but putting more pressure on GP’s mean they end

up leaving.’

‘Primary care do not care about patient participation, they just do it to spend their budget and tick boxes.’

‘A great pilot programme carried out called Community Navigators is a great model of improving links between the GP’s

and patients, funding for this model needs to be pushed.’

The clinician and community engagement specialists were also asked what they thought could be done to help engage a wider range of community members in helping to improve local health services. Their responses to this question were as follows:

Top themes

• Commissioning community specialists to build engagement in deprived areas developing better links with them and good relationships with these organisations 4/8

• Run public engagement events 2/8

• Health and Voluntary services to secure more funding for this work 2/8

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Other• Patients need to believe their voices are heard and that their voice will make a difference and their

needs will be met• Need to give patients more power in decision making• Need to educate people in early lives to feel valuable• Need to prioritise online movement• Get patients to take ownership of the NHS and believe that it is theirs• GP’s need to believe in and respect patients and patient participation groups.

‘If the NHS get the services right then we won’t need to do this work, we are looking at this the wrong way round.’

‘Health services are going to be facing more challenges in the futures, social care is facing more cuts which will put pressure on

Health Care Services. Everyone needs to work closely together and support each other.’

Final reflections from patients

We gave a space for any other comments and reflections, 97 people took advantage of the opportunity. Many comments reflected and reinforced key themes about what would help improve the service or were general reflections on the state of the NHS. A number expressed thanks for having their views asked in this way.

“Good and important to do this kind of work and to continue

reaching out to people.”

“There’s lots of things here that I’ve never really thought about before.”

“It was good to be asked these questions - that they care.”

“Carry on doing this work, it’s great.”

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In Conclusion

• 763 community members were involved

• 550 individual interviews

• 69 pop-up focus groups with 213 people

• 242 people (46% of people interviewed) gave their contact details and said they had interest in finding out more about being involved in helping to improve health services in Brighton. This could be in a variety of ways:

• Giving feedback (positive or negative)

• As part of an online panel

• Receiving a newsletter or other information

• Being part of a patients’ group, working with GP practises

• Supporting strategic decision making

• Being invited to discussions about specific conditions/service

• Everyone who was spoken with was offered a Heathwatch flyer

• Where relevant, people were offered the option to be referred straight to HWB&H to discuss any serious health concerns and the best way forward – 2 people took up this offer

We appreciated the opportunity to engage with members of the community in Brighton and Hove and were pleased that for such a high percentage of them this was the first time they had been involved in meaningful consultation about their local area.

Very often people assume that only those who engage with us already are the ones who are interested being involved in giving their views and shaping services. This consultation has really shown how flawed that assumption is. We were able to reach and engage people who have not been reached by other consultations and what we found is that a significant percentage of them were interested in finding out more about how they could be involved. There is obviously a gap between expressing broad interest and actually being involved, and work would be needed to bridge that gap and translate interest into action, but what we can see is that there is potential.

As stated earlier in the report, we acknowledge that we are not health sector experts and do not bring our own content knowledge to the analysis of this wealth of data. For this reason we have sought in almost all cases to report on what came out of the consultation rather than attempt to interpret the data. We would hope that health sector professionals will take the analysis to the next level in order to maximise the impact of the research and the data set we have provided. We believe that the data set will provide rich territory for analysis and hope that from this process the health service in Brighton and Hove (and potentially further afield) can be impacted positively.

We can, however give some feedback on the engagement process itself which could be useful to consider when planning future B&H CCG and HWB&H consultations. See Appendix 1 for details.


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Appendix 1 Feedback on the Engagement Process

The consultation and engagement process took place over a 4-week period from September - October 2015.

Face to face individual and group interviews were conducted in a range of places and at a variety of times and days of the week. To ensure a wide reaching consultation that involved a wide as possible net of the community, interviews were carried out between 6am and 11:30pm during the week and at weekends across Brighton.

The following is a synopsis of what we did, where we consulted and what worked best.

NB. There were areas we consulted in that had fewer people around so the numbers of people that we were able to consult with per hour was lower than in certain other areas, but it meant that as wide a range of people as possible were included.

Locations

Portslade High Street The main high street as well as the area near the train station were the busiest locations to consult at and had the highest footfall.

London Road Due the large number of shops on this stretch of road, this was a great area for consultation with a wide range of people.

Fleet StreetThis area with new housing complexes was not a good spot for consultation. It was difficult for community engagers to enter blocks of flats and many of the apartments were not occupied.

27 New England StreetHere there was a Sainsbury’s supermarket, behind which there was a café in a square. This area was good for consultation but less good between about 4-7pm as was busier and people were less willing to stop

St Peter's Church This area had shops, a green and a library nearby which made the location a good spot for footfall and engagement

Elm Grove This area predominantly involved door knocking-during the week there were very small numbers of people home to engage

Bear Road This street predominantly involved door knocking-during the week there were very small numbers of people home to engage

Lewes Road This was a good area for consultation as it is a main shopping area and had good footfall

Norfolk Square This predominantly involved door knocking-during the week there were very small number of people home to engage

Brunswick Square This predominantly involved door knocking-during the week there were very small numbers of people home to engage.

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Times of Day

• Best overall times for consultation were between 11am – 4pm. This was also true on weekends. NB if it had been in summer, it could have worked just as well until much later in the evening as people would have been outside much later

• Door knocking worked best during the weekends and less so during the weekdays as many people were at work.

• During the week days, door knocking after 5pm was more challenging as people were often not willing to engage

• In Portslade, street engagement worked best between the hours of 11am – 3pm.

• Street engagement worked best in general until 3:30/4pm, after which people were less willing to engage as they were making their way home or doing the school run, particularly between 4pm – 5pm.

• On Friday and Saturday nights, street engagement after 7pm became much more challenging; especially in the main bar and pub areas of Brighton. This was due to the fact that many people were out drinking and this made consultation results les reliable and more difficult to carry out.

• Consulting with people in the evenings during the week was much better as people were generally on their way home from work and not ‘out’ for the night. Consulting with people at bus stops and train stations on their way home from work between 5pm – 7pm on week day evenings worked better than on a Friday or Saturday night.

• Consultation worked best during weekends when people were out and about with more free time, especially before 7pm.

• Consultation, particularly street engagement, is affected by both the seasons and the weather. During the summer months there is more day light and it’s warmer so people are outside longer. This makes it much easier to consult up until at least 10pm. As this consultation was carried out during the autumn, sunset occurred at 7pm in early September and at 5pm in October. We don’t door knock after 7pm (as we don’t want to intrude) and as it became dark outside there were fewer people out and about to consult with. October was a particularly rainy month which also added another challenge to the consultation mix.

Places

• Green spaces and parks were very good spots for consultation throughout the daytime: consultation works very well when people are relaxing and on their lunch breaks

• Going into local businesses worked well during the daytime and the weekends, but less so when the shops were very busy. We went into a wide range of businesses eg. corner shops, cafes, hairdressers, library, printing shop, high street shops. The side streets worked best as the shop owners had more time to talk than in the busy main street shops.

• Going into local businesses earlier in the day when they were quieter worked well in consulting with shop owners/staff. Engaging with people in shops near their closing times was more difficult.

• Residential housing areas, such as Bear Road and Elm Grove were less productive than estates in terms of numbers we could consult with per hour. There were a larger number of people at home to consult with on estates during the day, whilst many of the residential roads were quieter during the daytime.

• Door knocking at new build apartments was also less reliable due to the fact that many of the flats were empty and gaining access to the buildings was difficult as they had security systems in place at the main doors.


Methodology

• Street engagement worked much better than door knocking throughout the consultation period.

• Street Focus Groups worked very well in parks and green spaces with groups of people, particularly on weekends.

• Individual questionnaires worked best during street engagement and in shops

• Street engagement in busy shopping areas worked better than door knocking on residential roads

• Door knocking worked best on estates rather than houses

Feedback on the design of the questionnaire

There was a mixture of questions and we designed the order of them to mirror a conversation. There are some opening questions that build relationship and are easy to answer but that also put people into a reflective mode eg. How do you rate your community?

The questionnaire was designed to be answered face to face and with someone talking with them who’s very good at engaging with a wide range of people, which is why we can have so many questions and have people answer them. If, for example, people were sent a questionnaire of this length and complexity, almost no one would complete it (and in many cases, wouldn’t even start it).

Some questions are harder for people to answer than others: eg when people are asked to come up with improvement ideas they typically find that harder than rating how things are now.

Each question builds on the next and then we get to the meat of the questionnaire, which may well take more thinking, and end with the demographic information.

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