Developing educational resources to improve primary healthcare services for people with Deafness and hearing loss

Deafness and hearing loss

2 November 2020

Dr Devina Maru, RCGP Clinical Champion for Deafness and Hearing Loss

Why the College has been focusing on Deafness and Hearing Loss

Hearing loss has been identified as the silent epidemic. It has been ranked as the fifth leading cause of years lived with disability in the Global Burden of Disease study. The Department of Health and Social Care, NHS England and Improvement (NHSE&I), Care Quality Commission (CQC) and National Institute for Health and Care Excellence (NICE) have recognised hearing loss as a major public health issue that must be considered in the strategies and plans aiming to reduce the impact of other long-term conditions. Projections show that the number of individuals with a disabling hearing loss could rise to 900 million globally by 2050.

There is a clear foundation for providing access to healthcare to people with hearing loss set by the Equality Act 2010. From August 2016, all NHS and social care providers have been required to meet the terms of the Accessible Information Standard (section 250 of the Health and Social Care Act 2012) and Care Quality Commission’s (CQC) checks this. The Department of Health and NHS England’s Action Plan on Hearing Loss (2015) also references the Standard and lists 'improved access to wider health services' as a key outcome measure for service improvement. However, findings still suggest that people with hearing loss still face challenges when accessing healthcare.

Research and Evidence

Twelve million people have hearing loss in the UK, and this is estimated to increase to 15.6 million by 2035. The total number of British Sign Language (BSL) users in the UK is 151,000 and, of these, 87,000 are Deaf. Between 20% and 50% of primary care appointments are related to ENT. Evidence suggests that people wait on average 10 years before seeking help after noticing signs of hearing loss and 45% of these individuals presenting to their GP are not referred to NHS audiology services. There is little training about hearing loss during undergraduate and postgraduate education, and up to date resources for GPs and trainees were slow to be developed following the release of the 2018 NICE guidelines, which  presented a clear  opportunity for improvement in learning provision for GPs and trainees. 

Access all areas report (294 KB PDF) looked into the experiences of people with hearing loss accessing healthcare including contacting and visiting their GP surgery, consultations with medical staff, and access to pharmacies. Respondents with varying levels of hearing loss completed the survey and the findings were eye-opening. There was a huge disparity between how patients currently contact their surgery to book appointments and how they would prefer to. As many as 47% of respondents visit their GP in person to make an appointment, yet only 14% identified this as their preferred method of contact. During GP consultations, 49% of respondents said that their GP surgery had a visual display screen, but one in seven respondents (14%) had missed an appointment because they had missed being called in the waiting room. NHS England has also estimated that the cost of people who are Deaf or have hearing loss missing NHS appointments could be as high as £15million every year. After attending their appointment, more than a quarter (28%) of patients were not clear about their diagnosis and unclear about health advice they were provided with.

The RCGP appointed a national Clinical Champion and collaborated with the Royal National Institute for the Deaf, NHSE&I and the patient public voice community to form a diverse stakeholder group. This group have been working to tackle the barriers impacting hearing health, and to raise awareness and reduce stigma associated with seeking help for hearing loss.

Resources Developed

A toolkit of educational resources has been developed to provide training and support around Deafness and hearing loss in primary care. This includes podcasts, an animation awareness video, a GP trainee teaching powerpoint, GP surgery charter and online learning including two Essential Knowledge Update modules, screencast and a RCGP accredited deaf awareness online course.

These resources give GPs the confidence to recognise the symptoms of hearing loss and appropriately refer people for a hearing assessment in a timely manner. They also support the implementation of changes in surgeries. The toolkit signposts further resources and aids learning by covering new additions of the GP curriculum in relation to hearing loss. It provides quality improvement initiatives and can help GP surgeries comply with legislation (Accessible Information Standard and Equality Act), as inspected by the CQC. Most recently, it has highlighted the importance of effective communication in light of the significant challenges brought about by the pandemic.


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