Primary care: what men want

In September 2005, the Department of Health launched a consultation process on community health care services called "Your Health, Your Care, Your Say” prior to a White Paper due for publication next year. In this article based on the Forum's response MHF Policy Officer David Wikins argues that both health professionals and men have a pretty good idea what needs to be done and much of it won't cost a lot.

We saw "Your Health, Your Care, Your Say” as an excellent opportunity to consult men directly through our website malehealth.co.uk as well as health professionals. We asked both groups much the same questions and got much the same answers.

Many men are dissatisfied with primary care. This is not whinging. The evidence (including our consultation of health professionals) suggests that primary care does not engage with men effectively. It is probable that the present system is contributing to the poor state of male health. Unless the White Paper acknowledges this, it is likely that the most promising opportunity in years to improve the health of men will have been missed.

We asked only open-ended questions. The results would have been remarkable in their repetition even if we had given respondents a fixed range of choices; the fact the same three themes recur again and again when men were free to say anything they liked, gives great weight to these being the key issues:

Opening hours

More than half of the men responding drew attention to the conflict between surgery times and working hours. The problem was perceived to be one which could be solved by more flexible opening hours (specifically, evenings and weekends).

This inconvenience was exacerbated by other problems including the distance from work to the GP surgery; the fact that GPs often run late, so that more time is needed for an appointment than is planned for; and the time-consuming nature of the appointments process

It is worth noting the overlap here with other factors associated with inequalities in public health. For example, men in the UK work the longest hours in Europe and men are almost twice as likely as women to work full time. It is likely to be the least well-off men who are employed in the kinds of jobs where time off to attend a GP appointment means wages lost.

Difficulties in accessing the doctor

More than a third of respondents drew attention to other practical difficulties in actually getting to see a doctor including:

• difficulty in making an appointment, queues and delays at the surgery, and bureaucracy in general;
• the dismissive, condescending or unsympathetic attitude of some GPs;
• the frequent requirement that patients discuss their needs with a receptionist first either on the phone or on arrival at the surgery. This lacks confidentiality and is seen as unwelcoming and obstructive. It may reinforce anxiety about "wasting the doctor's time” (this anxiety was expressed by some men in our consultation).

'We're not welcome'

Around a half of respondents either suggested that primary care was unwelcoming of men in some way. Again, there was a strikingly high level of consistency between respondents expressing these kinds of views.

• They saw primary care as a service primarily designed for women and children.
• They wanted changes in the primary care "experience” (e.g. staffing, decor, "customer services” etc.) to make it more "male-friendly”
• They called for specific "men only” healthcare services, especially for a regular "check up” service.

What about MHF members and stakeholders?

Our survey was also completed by a diverse group of professionals including: GPs and hospital doctors; directors of public health; nurses; academics; health promotion staff; PCT managers and staff from specialist voluntary organisations. Their answers revealed a high degree of correlation with those of our so-called "ordinary men".

Over half of respondents drew attention to the fact that many health services (not just primary care) are currently provided at times that are impractical for people in full time work,

Again, over half of respondents made the point that health services may make men feel unwelcome one way or another; health settings may be perceived as an "foreign environment" by men as one respondent put it.

Fewer health professionals than service-users identified problems with bureaucracy although men's "impatience" was mentioned in some responses.

Male "socialisation"

A majority of the health professionals suggested that during the course of their lifetimes, many men "learn" attitudes that pre-dispose them not only to poorer health behaviours (eg. greater "risk-taking" than women) but also to poorer use of services.

It was suggested that men are more likely to try to "tough out" illness, more likely to give priority to work commitments over treatment and rest, ore likely to have a self image that encourages them to deny illness, less likely than women to be prepared to discuss their health but more likely to fear the consequences of illness and disease

Since our respondents were people with hundreds of years of personal experience of working directly with men, their analysis of male attitudes can be relied upon. Services as they are presently constructed and delivered do not take account of these attitudes as well as they might.

In addition to the obvious but crucial point about more flexible opening hours, the responses to our second question about how services might be improved, fell very consistently into clearly discernible themes.

If men cannot — or will not — come to health services, then services should go to them. It was felt especially important to develop partnerships with employers and occupational health sevices.

Regular "MOTs" were thought to be particularly appealing to men. It was suggested that these could be offered by (say) annual invitation, or made available in "hassle free" settings, "walk in" clinics or mobile units.

The need for a change in ethos was made numerous times. Services tend to be provided on the basis that the service user will be able to identify his or her own need initially before willingly going along to the service provider and expressing that need fully and frankly. He or she will then proceed to accept the advice and treatment that is offered, using the delivery mechanisms that the service provider has in place.

It is possible that this model works better for women than men. Evidence and anecdote suggests that men are less likely to come forward and more likely to be constrained from making the best of the service by their view of themselves as men — and indeed, by the cultural view of masculinity that is imposed on them (not least, often, by health service providers). Our respondents variously suggested staff training; changes in the structure and "marketing" of services; and more research into male attitudes as means of responding to this difficulty.

What do men want?

Those respondents who answered our question about the new service they would like to see in their own community, overwhelmingly called for regular, informal health checks delivered in male-friendly environments (away from primary care was often specified).

Putting together the 100 or so answers received to this question gives us a picture of a service that looks like this:

• Free
• Informal
•  "Walk-in” (appointments and pre-booking not necessary)
• Available outside working hours
• Designed primarily to offer screening, check-ups and advice
• Not judgemental and does not "lecture” patients
• Personal i.e. offers private consultations tailored to the needs of the individual

Additionally, it probably:

• Takes place away from the primary care setting (it is perhaps, "mobile”)
• Is for men only
• Is largely staffed by men
• Offers information using new technology, which might also be available remotely

It might also:

• Concentrate on "fitness”
• Happen in the workplace
• Call men in for health checks on a regular basis (e.g. an annual invitation to attend)