Written evidence submitted by The Royal National Institute for Deaf People (FGP0181)

 

Executive Summary

 

 

Introduction                                                                     

 

1. RNID is the charity making life fully inclusive for deaf people and those with hearing loss and/or tinnitus. We fund research to find a cure for hearing loss – driving the development of new technology; campaign to change public perception and policy for deaf people and those with hearing loss and/or tinnitus; and provide practical information and support.

 

2. RNID welcomes the opportunity to submit evidence to the Health and Social Care Select Committee Inquiry “The Future of General Practice”. Our submission details the issues facing deaf people and those with hearing loss and/or tinnitus both in terms of general access to information they need in obtaining treatment and the technology they may need to use when accessing GP services remotely.

 

3. There are currently 12 million adults – 1 in 5 - who are deaf or have hearing loss in the UK. One in 8 people have tinnitus.  Unmanaged hearing loss can impact an individual’s health and quality of life. People with unaddressed hearing loss have an increased risk of isolation and mental illness, such as depression. We also know that those with age related hearing loss will also be likely to suffer from other age-related health conditions including dementia and falls. Without sufficient communication support, deaf people and people with hearing loss are more likely to be isolated, experience poor health care and have reduced independence. This is because communication barriers exist for people with hearing loss, tinnitus and people who are deaf. These barriers can be reduced or exacerbated depending on the utilisation of technology and other adjustments that are or are not made.

4. When considering the impact of living online for deaf people and those with hearing loss and/or tinnitus, accessibility should be at the forefront of minds for the Government, employers and health and social care professionals.

 

5. In this submission, when we refer to “patients”, this should be interpreted as “patients who are deaf, or have hearing loss, and/or have tinnitus” and when we say “communities” this is an inclusive term for separate groups of people who are deaf, or have hearing loss, and/or who have tinnitus.

 

6. RNID conducts extensive social research amongst the communities we support about a range of issues. This helps us to build an evidence base to support our influencing, campaigning and policy development. In recent months, we have received several comments and complaints which highlight the barriers that can be faced in obtaining effective and timely healthcare.

 

What are the main barriers to accessing general practice and how can these be tackled?  

 

7. For our communities, the main barriers can best be characterised as (i) patients find it difficult to make appointments because the information they need may not be in a form which is accessible to them; (ii) problems communicating with GP practice staff and the GP; and (iii) further difficulties faced by patients if they are referred to other parts of the health system for further investigation and/or treatment because they have to keep explaining their specific communication needs.

 

8. We consider that it is the best interests of patients that they are offered the opportunity of having a face-to-face consultation with a GP, particularly if there are any concerns that a remote consultation could lead to difficulties in communication clearly and with an appropriate level of confidentiality.  We are very concerned at any suggestion that remote consultations are the default setting.  We do, however, support a hybrid model whereby some care can be delivered remotely where this is the patient’s preference and does not adversely affect the quality of treatment needed, as long as the appropriate technology is utilised with the patient offered the necessary communication support such as video or text relay.

9. RNID has worked closely with the Royal College of General Practitioners to develop a Toolkit for use by GPs and their practice staff.  This resource contains a wealth of useful information and training/briefing materials. The toolkit can be accessed through the following link:

 

Deafness and hearing loss toolkit: Introduction (rcgp.org.uk)

 

10. RNID consider that wider adoption of the principles and practice set out in the toolkit would greatly enhance the experience for patients and would significantly reduce the levels of anxiety and stress which they frequently report to us. We would welcome support from government bodies including the Department for Health & Social Care and NHS England in promoting this valuable resource.  We would also wish to see more widespread uptake of services such as Relay UK and sign relay services for remote appointments and face to face appointments.

 

To what extent does the Government and NHS England’s plan for improving access for patients and supporting general practice address these barriers? 

 

11. It is encouraging to note that the Long Term Plan proposes a migration to a new service model in which patients get more options, better support, and properly joined-up care at the right time in the optimal care setting. We particularly welcome a move towards greater integration and plans to create an extended range of convenient local services.  However, RNID believes that it is important that everyone working in primary, secondary and community care understand their legal obligations in implementing the Accessible Information Standard in all cases, so that these fully meet the requirements of patients who are deaf, have hearing loss and/or have tinnitus.

 

12. We also welcome proposals for new funding for the NHS to strengthen its contribution to prevention and health inequalities. We consider that there is a strong and compelling case for greatly enhancing awareness of the importance of good hearing and for the widespread introduction of routine hearing checks as part of the overall assessment of the health of all patients. This will greatly improve the likelihood of early intervention and arranging for suitable treatment or further advice

13. We believe there is an important role for hearing screening and the early treatment of hearing loss in these initiatives. There is an abundance of evidence to show that early intervention with hearing loss has the potential to make a huge difference to an individual’s overall health and wellbeing – and therefore also to the long-term sustainability of the NHS and its finances. For example, there is evidence that around 8% of dementia cases could be prevented with early and effective treatment for hearing loss. We also know that unaddressed hearing loss potential doubles the risk of depression. We therefore think that preventing, identifying, and treating hearing loss has the potential to be a vital part of the proposed National Prevention Service. We believe that incorporating a systematic programme of hearing screening into the Service, as it subsumes the NHS Health Check, would deliver substantive improvements in patients’ quality of life and the sustainability of the NHS.

14. We also are encouraged by proposals for a programme to upgrade technology and provide digitally enabled care across the NHS.  However, our view is that this must be designed and delivered through drawing on the insights and views of patients with lived experience.

 

What are the impacts when patients are unable to access general practice using their preferred method?   

 

15. When patients are unable to access general practice in their preferred method, there are several negative impacts. These include:

 

 

16. Furthermore, 70% of over 70s have hearing loss, and this group is more likely to experience age-related illness and co-morbidities that are managed in general practice. Therefore, it is essential that general practice is accessible to all patients in their preferred format.

 

What role does having a named GP—and being able to see that GP—play in providing patients with the continuity of care they need?  

 

17. Having a named GP means that the patient does not experience raised levels of anxiety when planning and making an appointment and visiting the practice, and this makes a huge difference to supporting prompt diagnosis and treatment. It is also important that those who work in the GP practice understand what adjustments are needed, and that when the patient is referred for treatment elsewhere in the NHS that there is effective communication from the practice to other parts of the health service.

 

What are the main challenges facing general practice in the next 5 years? 

 

18. RNID has no comments to offer.

 

How does regional variation shape the challenges facing general practice in different parts of England, including rural areas? 

 

19. Particularly in rural areas, having the option for consultations with a GP using telephone or internet technology is vital in ensuring continuity of care for patients who may difficulty with travelling (or arranging travel).  However, this important option will only be effective if the specific communication needs (e.g., if appropriate, the provision of a British Sign Language Interpreter, use of Relay UK or captioning services in video calls) are recognised when the appointment is made, and then confirmed to the patient and subsequently met during the appointment.

 

What part should general practice play in the prevention agenda? 

 

20. RNID believes general practice has a key role to play in helping patients take early action on their hearing loss, thereby helping to reduce the risk of, or prevent associated co-morbidities that arise through delayed intervention.

 

21. Evidence shows that early intervention for hearing loss leads to improved hearing health outcomes, such as increased benefit from hearing aids, compared to delayed treatment[1]. Furthermore, evidence suggests that the use of hearing aids leads to improved communication, mental health, and quality of life[2]. Conversely, unmanaged hearing loss is associated with several mental and physical health conditions, including:

There is also a growing body of evidence showing a link between hearing loss and an increased risk of developing dementia, suggesting 8% of all dementia cases could be preventable through management of hearing loss that arises in midlife[7].

 

22. Despite the risks of not taking action outlined above, many people do not seek help for their hearing loss when they first notice the signs, on average people wait for around 10 years1. This could be due to several reasons, such as lack of awareness of the signs of hearing loss, being unaware treatment options and pathways (free NHS hearing aids obtained by a referral to audiology), reluctance to address acknowledged hearing loss, or lack of awareness of the risks of delaying treatment.

 

23. Doctors in General Practice are uniquely placed to give advice and information about this to their patients, many people trust the knowledge and advice of their GP and they are likely to regularly attend general practice more than other health services. Furthermore, the World Health Organisation has recently recommended that hearing be included within national health checks for those over 50[8]. While this recommendation has yet to be translated into policy within the NHS, GPs can (and should) routinely enquire about hearing with this patient group, making referrals to audiology as necessary.

 

What can be done to reduce bureaucracy and burnout, and improve morale, in general practice?   

 

24. RNID has no comments to offer.

 

How can the current model of general practice be improved to make it more sustainable in the long term?

 

25. Greater innovation in service delivery will ensure that GPs have sufficient time to devote to those patient consultations and interventions which are the sole responsibility of the GP within their scope of practice. We strongly support the involvement of patients with lived experience in the design of services so that these can be as effective, credible, and inclusive as possible.

 

Is the traditional partnership model in general practice sustainable given recruitment challenges, the prioritisation of integrated care and the shift towards salaried GP posts? 

 

26. RNID has no comments to offer.

 

Do the current contracting and payment systems in general practice encourage proactive, personalised,coordinatedand integrated care? 

 

27. RNID receives many complaints about the difficulties experienced in some areas in obtaining ear wax removal carried out by their GP practice.  We understand that as ear wax removal is no longer part of the standard GP contract it is left to the discretion of individual practices to decide if they will offer this service.  We wish to see greater consistency of provision of this service so that patients are offered suitable options for wax removal if these will not be provided by GP practices.

 

Has the development of Primary Care Networks improved the delivery of proactive, personalised,co-ordinated,and integrated care and reduced the administrative burden on GPs? 

 

28. RNID has no comments to offer.

 

To what extent has general practice been able to work in effective partnerships with other professions within primary care and beyond to free more GP time for patient care? 

 

29. One of the major concerns for patients is the waiting time to be able to see a GP and, subsequently, the additional delays which arise from being referred into the treatment pathway. This problem could be mitigated to some extent by more innovative thinking into alternative models for delivery for services where it is not critical (from a scope of practice viewpoint) for the patient to see the GP (at least in the first instance). 

 

Conclusion

 

30. People who are deaf, have hearing loss and/or tinnitus are entitled to receive the same high quality of service from their GP as all other patients.  For our communities, it is essential that each patient can consult with their own GP on every occasion. 

 

31.  Patients in our communities need specialised communication arrangements.  GPs and their practice staff have a legal obligation to implement the Accessible Information Standard.  Comprehensive advice is available to GPs through an online toolkit and RNID strongly recommends that these are actively promoted through NHSEI to GPs. 

 

32. While the use of digital technology supports the delivery of healthcare against a backdrop of increasing demand, it is important that patients from our communities are allowed to express their preference for how consultations should be conducted and should not be discouraged or prevented from doing so because they have specialised communication requirements.

 

RNID

 

[2998 words]

 

December 2021


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