GP Access Project (Blind and Visually Impaired Service Users) HEADLINES. The Right to Sight

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1 GP Access Project (Blind and Visually Impaired Service Users) HEADLINES The Right to Sight

2 Background Project Duration: 18 months. Funded by DOH/RNIB/UK Vision Strategy Project Duration: 18 months. UK Vision Strategy Guiding Principles: Improve the eye health of the people of the UK Eliminate avoidable sight loss and deliver excellent support to those with a sight problem Enhance the inclusion, participation and independence of blind and partially sighted people. The National Health Information Centre states that eye care comes second only to trauma for all referrals by GPs to secondary care. There are 36 GP Practices in Tower Hamlets; an average Practice will have around patients with significant sight loss, which equals 5,400-7,200 patients who may face barriers to access. RNIB projections for sight loss in the UK by 2020 suggest that expenditure due to AMD, glaucoma, cataract and diabetic retinopathy is set to grow substantially. By developing cost effective interventions/strategies some of this cost can be defrayed and result in improved service delivery and uptake. Tower Hamlets has the lowest uptake of the over 60 NHS eye test of all London Boroughs/PCTs; only 1 in 5 take this up. PHAST report recommends targeted public awareness; GPs are in the optimum position to remind people of the need to get sight tested and evidence shows that advice from a GP is effective.

3 Outline of Project Aim: To improve GP Access for the visually impaired (Phase 1 of project) - Data gathering and analysis Service Users, GP Practices, RNIB Joint Mobility Unit Access Audits 1) Pre-appointment issues 2) At the Practice prior to Consultation 3) The Consultation 4)Format and Information Recommendations to inform design of training programme Recommendations to inform design of information resource pack (Phase 2 of project) - Training programme to be rolled out over 36 Tower Hamlets practices (Phase 2 of project) - Information resource pack to be produced (Phase 3 of project) - Evaluation

4 Ethnicity and Age ranges (44 Service Users over 24 Practices) Breakdown of Nationality Age Range Nationality Number Gender Black African 1 1 female Afro-Caribbean 2 1 female 1 male Bengali 9 5 male 4 female Black British 2 2 female Indian/British 2 1 male 1 female Indian/Hindi 2 1 male Sierra-Leonean 2 1 female 1 male 1 female Nigerian 1 1 female White British 22 7 male 15 female White Irish 1 1 male Total female 17 male Age range Total Male Female Total

5 Key Findings The level of patient experience and satisfaction varied considerably between GP Practices (and sometimes within the same Practice), as did the level of accessibility and responsiveness of GP Practices There was sometimes striking discordance between Practice feedback and Service User experience Key Finding per Category Pre-appointment 28 service users do not believe that their visual status is flagged up on their records, or that frontline staff are aware of their visual impairment. This is significant from the moment the patient contacts the Practice Pre-consultation 20 service users experience acute problems with notification of consultation; most struggle to read dot-matrix board; occasionally, a patient is called but then left to find the consulting room, then struggles to negotiate corridors and signs.

6 Key Findings Consultation There is a general satisfaction with the GP consultation. Nevertheless, a number of patients complained of seeing a stream of different locums who are not aware of their visual impairment One patient feels very strongly that the GPs do not know or understand his eye condition and that if they did, they would cope with him better. Format and Information Few Service Users are aware of the Disability Discrimination Act. Most, when asked, express a preferred choice of format for communications but have not thought to state this, and have rarely been offered this by the Practice.

7 30 Format and Information Yes Count Large print Audio Aware of DDA Prescription issues Braille Requested preferred format? Offered format choice

8 Key RNIB Audit themes All 3 Practices would benefit from visual awareness training; it is in the interests of promoting disabled peoples independence, rather than relying on assistance, that many of the training recommendations are made. Almost 100% would be happy to have a mystery shopper, and some felt that they would welcome this as a motivating force. Several Practices would welcome the opportunity to receive access awareness training which is encouraging. Signage schemes need to be accessible, incorporating good practice features such as visual contrast, suitable typeface and font size, raised tactile elements and consistent positioning. As the appointment announcement system may not be accessible to those with sight loss, hearing loss or learning difficulties, there needs to be staff disability awareness training to help staff provide necessary assistance

9 Recommendations Suggested Improvements Ask, identify, record and flag patient s visual impairment status Ask, identify & record individual s preferred communication needs, including first language Ensure ability to provide accessible information (appropriate format) specific for individual need, including communications being produced in appropriate language Ask, identify & record what assistance an individual may need Ensure staff s ability to provide assistance (visual awareness training) Ensure accessibility via the phone Inclusion of visually impaired individuals patient participation Identify the barriers which need removing Focus on being inclusive There needs to be an improved awareness of rights and services Ensure access to appropriate information technology Explore availability of double appointments

10 What Next? Stage 2 Summary Plan The above findings will be incorporated into the training package, which will be finalised and piloted in 2 Practices by the end of August. A strategy of delivering the training package will be devised, involving intense communication and embedding with GP Practices, the Practice Manager forum, Networks, Small Practice forum etc. Service users will be consulted and involved with the development of the training package. A detailed plan will be produced by 30 th July for the first 3 months of phase 2 as well as an outline plan for the whole of phase 2. Concurrently, work will continue on the information/signposting resource pack, making use of existing information, where possible, eg UK Vision Strategy Charter, and designing simple information/communication fliers for specific Tower Hamlets issues. A top priority will be to formalise project measures. Partnership working will continue with RNIB to develop the best practice system for utilising EMIS web to flag up visual status reliably, as well as patient requirements and format/communication choice.

11 NHS Tower Hamlets has appointed Vivien Wilkinson as Project Manager (Eye Health), GP Access. The aim of her work is to ensure that best practice principles are in place for the blind and visually impaired when visiting their GP, from initial contact right through to the session in the GP s consulting room. Vivien is particularly concerned to make contact with sight-impaired people who feel isolated, or are hard to reach. Please contact her if you are able to help her with her work by talking about your experience when visiting your GP, or if you know of anyone who might be willing to help: Vivien Wilkinson Project Manager, GP Access, Eye Health Team NHS Tower Hamlets 81 Commercial Road London E1 1RD Telephone: Mobile: vivien.wilkinson@thpct.nhs.uk