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Tackling ableism in health care – the role of primary care

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Getting a GP appointment is often a challenge at the moment, but for many disabled people, access to their GP has long been a problem. In our recent project exploring disabled people’s experiences of involvement in health and care design, people told us about their experiences accessing health and care, as well as of involvement in service design.

Some participants described the significant difference a GP could make: those who made someone feel listened to and validated, compared with GPs who dismissed concerns or spoke to a person’s personal assistants rather than directly to them.

The experiences of people with communication needs in general practice are particularly stark – a recent review of the Accessible Information Standard highlighted that only half of this group had an accessible way to contact their GP. The review also found that more than a third of health professionals have never received training about this standard, despite it being a legal requirement for all NHS organisations since 2016. Poor experiences trying to access primary care can lead to people giving up on engaging with health care, with all the risks that entails. It’s vital that we tackle ableism in health care – so what can GPs do?

In March 2023 I met with a group of GPs on the East of England Trailblazer Deprivation Fellowship Scheme, which supports newly qualified GPs  working in areas with high deprivation. These GPs meet regularly to share best practice on reducing health inequalities for marginalised groups in the places they work. I was asked to talk about health equity for disabled people, and during the session we discussed access for disabled patients, the issues GPs encounter trying to reduce these barriers and what solutions might look like.

'While some of the access issues GPs highlighted were familiar, relating to physical access to GP practices in older buildings, or fixed examination beds, issues like booking an appointment highlight how access is not straightforward.'

GPs told me about some of the ways they aimed to reduce barriers for patients – for example, double appointments for a patient with additional communication needs, or seeing a patient who might struggle in a busy waiting room at the start of a session. However, these solutions were not necessarily compatible with how patients booked appointments on online systems – for example, patients often don’t have the option to request a double appointment or flag their access needs. While some of the access issues GPs highlighted were familiar, relating to physical access to GP practices in older buildings, or fixed examination beds, issues like booking an appointment highlight how access is not straightforward.

Unsurprisingly, the pressures GPs are under at present came up repeatedly; but the variation between practices was also evident. Some had good experiences of practices where the team was aware of access issues, and reception staff supported GPs by highlighting a patient’s communication needs to the GP and helping address them before their appointment. Where teams were less aware, GPs could feel alone in their attempts to support disabled patients. Good practice resources were available, but often developed by GPs who had noticed the lack rather than consistently produced and disseminated, and not all in this group were aware of them.

What struck me most from talking to these GPs was the extent to which their own ability to support disabled patients relied on the practical processes and information systems, other colleagues, and wider health and care system partners. For example, patients are ‘bounced back’ to their GP if their needs for access are ignored or not facilitated by secondary care, or if care workers for a person with severe learning disabilities were not able to adequately describe the symptoms that needed addressing. But there were also examples of the wider team supporting GPs’ work: social prescribers supporting patients to understand the services that are available to local disabled people, reception teams knowledgeable about disability and supporting access to appointments, and networks of GPs like this one enabling them to share information about good practice resources.

'While individual clinicians being disability aware is vitally important, its equally important to address systemic barriers to access.'

While individual clinicians being disability aware is vitally important, its equally important to address systemic barriers to access. This conversation showed how using the knowledge and insights of the wider general practice team can help develop solutions. Given the importance of general practice as a gateway to the wider health system, GPs do have a key role – but this will need the support of wider health system colleagues too.