Overview
This report, published by Healthwatch Southend in May 2023, explores the experiences of deaf people when accessing general practice services in Southend-on-Sea. The work was carried out in partnership with the Royal Association for Deaf People to ensure that people who use British Sign Language (BSL) were able to share their experiences fully.
The report highlights persistent barriers faced by deaf patients at every stage of the GP pathway, from booking appointments to communication during consultations. It provides important insight into how failures to meet communication needs can negatively affect access, dignity, safety and health outcomes.
Aims and methodology
Purpose of the research
Healthwatch Southend undertook this work to better understand why deaf people often experience poorer access to healthcare and worse outcomes, and to identify where general practice could make reasonable and achievable improvements.
The intention is to use this insight to inform improvements in primary care access and to support compliance with existing legal and NHS requirements.
How the insight was gathered
The research was conducted in Spring 2023 through facilitated discussions with members of the Southend Deaf Club. Participants were asked about:
- Booking GP appointments
- Use of technology and communication tools
- Whether practices asked about communication needs
- Experiences on arrival at the surgery
- What happens during consultations
The findings are based on lived experience accounts rather than quantitative survey data.
Key findings
Barriers to booking appointments
Deaf participants consistently reported difficulty booking GP appointments. Many practices rely heavily on telephone-based booking systems, which are inaccessible for people who cannot use the phone. While some participants attempted to use email or attend surgeries in person, responses were often delayed or they were still asked to phone the practice.
Several participants described having to rely on friends or family members to book appointments on their behalf, removing independence and, in some cases, privacy. Booking appointments that required a BSL interpreter often led to long delays, sometimes of two weeks or more, or appointments being cancelled entirely due to interpreter availability.
Communication needs not being recognised
Although many participants had their deafness recorded on their medical records, this information was not always visible or acted upon by reception staff or clinicians. Deaf patients frequently had to repeat their communication needs, and in some cases reported never being asked how they preferred to communicate.
Assumptions were often made about deaf people’s literacy. Some participants were expected to communicate through written English, despite English being a second language for many BSL users. This led to stress, misunderstandings and reduced confidence in accessing care.
Use of technology
While some participants had access to smartphones or assistive software, many felt unsupported in using digital systems to contact their GP. Text messages from practices were often sent via “do not reply” systems, meaning patients still had to ask someone else to make contact on their behalf.
Participants also reported that some GP practices were unwilling or unable to engage with communication technology that could support deaf patients, limiting the effectiveness of digital access routes.
Experiences at the surgery
Arriving at the GP surgery was often described as stressful. Deaf patients reported missing appointments because they could not hear their name being called, particularly in busy or noisy waiting rooms. Visual calling systems had been removed in some practices, increasing reliance on verbal communication.
Face masks created additional barriers by preventing lip-reading, and some participants described feeling anxious or embarrassed when trying to explain their needs at reception desks without privacy.
Experiences in consultations
Communication challenges continued in the consulting room. Some participants reported that GPs were unwilling to write things down, or wrote in ways that were difficult to understand. Others were asked to bring family members or friends to interpret, which was experienced as inappropriate, undignified and a breach of confidentiality.
For those with mental health needs, these communication barriers increased anxiety and made accessing care even more difficult. Continuity of care was particularly important, with participants reporting better experiences when seeing clinicians who already understood their communication needs.
Legal context and standards
Equality and accessibility duties
The report highlights that deaf people are protected under the Equality Act 2010 and that all NHS-funded services must comply with the Accessible Information Standard. This includes identifying, recording and meeting patients’ communication needs and ensuring accessible information and support are provided.
Despite these requirements, the experiences shared indicate inconsistent compliance across GP practices.
Conclusion
Healthwatch Southend recognised the significant pressures facing general practice but concluded that deaf patients have a right to access GP services without avoidable barriers. The experiences shared through this research were described as disappointing and concerning, particularly given the existence of clear legal and NHS standards designed to prevent such issues.
The findings show that barriers exist throughout the entire patient journey, from appointment booking to consultation. Too often, assumptions are made about deaf people’s ability to communicate, and inappropriate reliance on family members for interpretation continues despite the availability of professional services. These issues risk poorer health outcomes, reduced trust in services and breaches of patient dignity and confidentiality.
Recommendations
The report makes the following recommendations to the Mid and South Essex Integrated Care Board, as commissioner of general practice services:
Improving compliance and oversight
The ICB should audit local GP practices’ compliance with the Accessible Information Standard, with the involvement of deaf patients, to ensure communication needs are being identified, recorded and met consistently.
Building deaf awareness and skills
Deaf awareness training should be provided to GPs and all practice staff to improve understanding of communication needs and reduce reliance on inappropriate assumptions.
Supporting accessible communication
Practices should be supported to use appropriate technology to facilitate communication, ranging from visual calling systems in waiting rooms to software such as SignRight during consultations.
Strengthening interpreter provision
All practices should be aware of, and actively promote, professional translation and interpretation services. The effectiveness of interpreter contracts should be monitored with direct involvement from deaf patients.
Embedding accessibility in access recovery plans
Local responses to the Delivery Plan for Recovering Access to Primary Care should explicitly consider the needs of patients with communication requirements, including deaf people.
Read the full report