‘We do all want to help our blind patients, but we often do it in the wrong way,’ says Paul Frisby a GP in Eastbourne, East Sussex.
Around two million people in the UK have lost at least part of their sight and the proportion is particularly high in older people, with blind and partially sighted people making up one in five people aged over 75.
However, GP surgeries often have a long way to go accommodating those patients’ needs.
East Sussex Vision Care (ESVC), a partnership between three local associations of blind and partially sighted people, has produced a report that collates members’ experience of the NHS from the GP surgery through hospital care and beyond.
Not just eye health
The report, ‘The National Health Service Experience for Vision Impaired People’, is available on request from the three ESVC associations (details below).
Importantly, it does not focus on eye problems, but on the patient's health more generally.
Blind and partially sighted people use the NHS for a whole range of reasons – especially since their age profile means a lot of patients have other health problems and/or other disabilities.
However, if GP practices do not accommodate the vision problem and, crucially, fail to mention it in any referrals they make, the ‘whole’ patient suffers.
‘We’ve found time and time again that someone will go in with one problem – say a heart problem – and come out with their vision and their health both deteriorating,’ says Deirdre Dean, chief executive of Eastbourne Blind Society.
‘Around 10 years ago I was a hospital inpatient,’ adds Christopher Wooller, chair of the Society’s user group. ‘The referral from my doctor didn’t make it clear that I had sight problems, so that staff did things like put a glass of water out of my reach, and hang up the buzzer when they made my bed.’
Access to GP premises
Compared to other parts of the NHS, GP surgeries come out relatively well in the report, with a lot of patients saying that they are fairly happy with the service they receive.
Physical access for blind people is generally good, with ramps and sometimes automatic (talking) doors although these are not always clearly enough marked.
However, the signs, touch screens and displays are often completely inaccessible, including the visual display signs to call patients to the consulting room.
Many patients are also happy with what happens inside the consulting room, and a number of GPs are already making particular efforts to accommodate blind and partially sighted patients.
At the same time, many others feel that their GP does not realise that their sight problem often has an impact on the health issue they have brought to the surgery.
For instance, blind and partially sighted people can miss a lot of ‘obvious’ signs like passing blood, or changes to moles.
Other problem areas
Bear in mind that any referral (especially to hospital) needs to mention that the patient is blind or partially sighted to accommodate their needs - including, sometimes, sight-preserving medication.
Some GPs also prescribe medications in small boxes rather than the blister packs that blind patients prefer.
There are also a lot of concerns about other practice staff and sometimes fail come across as friendly and approachable for help. For example, receptionists may give directions like ‘take a seat over there’ which are completely standard, but not appropriate for patients who cannot see ‘over there’.
The encouraging thing about such problems is that they are often extremely easy to tackle. Some do require minor physical adjustments, but many of them are simply about the way the patient is treated.
Dr Frisby, who has long-standing links with ESVC, has already brought in one of his blind patients to talk to the practice team about helpful changes they can make.
‘We are much more aware of the physical environment,’ he says.
‘We’ll say if we’ve moved the chairs around in the waiting room, or arranged the office differently. We are trying to make the waiting room environment a place that feels calm, safe and secure.
He explains that building work done on the surgery, means there have been changes to its access, with fewer trip hazards and a lift that blind patients can also use.
Dr Frisby says the tea at his practice have realised 'how important it is to say what you are doing - for instance, that you’ve turned away to type up notes on a computer - to someone who can’t pick up on the visual cues.’
Team members have also learned to explain what they are doing, what any strange noise is, or if someone else has come into the room. ‘If a patient does have a bit of vision, I’ll also describe myself to them,’ Dr Frisby adds.
The other thing his practice has been doing for a while is making sure that letters it sends to patients are in a font they can use easily. Clinicians also read out hospital letters to them.
'In fact, I now ring up [hospitals] on patients’ behalf and ask that they’re phoned instead of sent letters in the future,’ he explains.
Mr Wooller adds: ‘It comes down to awareness; 80% of what’s in the report is about awareness. That’s what needs to be built into everyone’s training.’
The National Health Service Experience for Vision Impaired People is available from the following organisations: