In this sample, young adults’ use of primary care services varied from rare attendance to frequent visits. Reported experiences of primary care services and with professionals were generally positive. However, the transition from adolescence to adulthood appears to give rise to specific problems for young adult users, including difficulties negotiating the primary care system, issues with mutual trust and communication difficulties with their GP. An accumulation of a lack of experience in negotiating and understanding the healthcare system and a problematic relationship with the GP led to some young adults using other, more obviously available primary care services, such as the walk-in centre.
The idea that young people lack the cognitive or psychosocial maturity to effectively use the health care system is not novel , but it is apparent that difficulties continue to be experienced. Young adults are at a stage in their lives where they are developing an increased autonomy in every aspect of their life, including the decision to seek medical advice when needed. Some young adults lack understanding of how the health care system works, what their rights are as a patient, and what services are available to them from their local GP surgery. In addition to this, the ever changing landscape of primary care can be challenging to keep up to date with for young adults. For example, many practices have embarked on changing appointment systems to a total triage model which may either hinder or make access to services easier for this age group. However, effects of these changes on access and care for young adults have not been researched or explored. As shown in this study, young adults’ inexperience and lack of knowledge of current primary care systems can lead them to use other more accessible services such as a walk-in centre or the accident and emergency service within a hospital, impacting on their workloads.
There is recognition that a smooth transition from child and adolescent care to adult care for individuals suffering from chronic physical and medical conditions is important and best practice guidelines have been developed to ensure services address the needs of young adults during this transitional period [30, 31]. These guidelines do not, however, extend to the general young adult population not suffering from any chronic physical or medical condition. As young adults become responsible for their healthcare during this transition, there is an increasing need to support them in developing their communication skills, assertiveness and decision making skills in order to effectively manage their own healthcare.
Effective communication between the patient and GP is integral in any successful consultation. Our research has shown that young people consider the communication skills of both the healthcare professional and the patient to be important aspects of the consultation process. There are difficulties in this regard as our results showed that some GPs are not perceived to take young adults’ health concerns seriously or to explain things clearly. The Royal College of General Practitioners (RCGP) recognise the importance of GP communication and how effective communication skills can help build trust in the GP-patient relationship which can be strengthened over time through continuity of care . This formula of effective communication, trust and continuity of care can improve patient reported health outcomes and patient satisfaction. Some interviewees in this study reported problems conveying their symptoms and being adequately listened to by their GP; this could potentially lead to an inaccurate diagnosis and an inappropriate treatment plan. In such circumstances a lack of trust may then develop regarding the GP’s capabilities and the service they provide, which can cause young people to stop using that particular service and seek alternative care. As mentioned previously, there is a tendency among young adults to use alternative services such as the walk-in centre or A&E can create an unnecessary, additional strain on those services. Recent data published by the Health and Social Care Information Centre report that the 18–28 age group represent 18% of attendances at all A&E units and walk in centres and minor injury units see a higher proportion of younger patients in comparison to major A&E units .
The introduction of the salaried service for GPs where the length of the contract may be shorter also means that GPs can move practice more often. Providing stability and continuity of care with familiar health professionals, which has emerged as important to young adults, will be a challenge to the new generation of primary care providers who are more mobile than their predecessors. Understanding how GPs move between different practices has an effect on the provision of continuity of care to patients is important as it has been identified by young adults as a significant aspect of care, however it is currently under-researched.
Another concern raised by interviewees related to informed consent and confidentiality, especially with regard to sexual health issues. There was also a lack of understanding about their rights as patients once young people become legally responsible for their own healthcare. Our findings suggest that specific targeted leaflets providing young adults with information regarding their rights as a patient may be beneficial in educating, empowering and enabling them to take responsibility for their healthcare. Assurance from the GP about the confidential way in which personal information is handled is essential early on in the process, as this will assist in the development of mutual trust between the patient and GP.
Communication problems are also experienced at a practice level as young adults are unclear about the services that are offered within their own surgeries. The lack of clarity around service availability lies both with the clinician and patient. Due to technological advancements and the increased use of social media, it is important for providers to consider creative ways to convey information about their services to the younger population. Equally, younger patients should be able to identify a preferred method for receiving information regarding their GP surgery. Our findings suggest that patients and providers should work together in order to achieve a service which addresses patient needs through the means of communication appropriate for the different age groups (e.g. use of email/text for younger patients and more traditional methods for older patients).
Every year the lowest responders to the national GPPS are young adults aged between 18 and 24. The attitudes of our young adult interviewees towards surveys were mostly ambivalent. The majority were unaware of the existence of a national survey, and only a minority of respondents stated that they would complete it. The reasons suggested for the low participation rates of young adults mainly related to the length of the questionnaire and the topic area. Many young adults expressed little interest in completing a long survey about their perceptions and experiences of a health care service. Despite this, some young adults recognised that their responses were important, as they might affect the services provided in the future. Incentives and online surveys were highlighted as possible methods of increasing response rates to such surveys, as well as shortening the length.
Strengths and limitations
Despite previous quantitative studies investigating the perceptions and experiences of patients accessing primary care services, to the best of our knowledge, this is one of the few studies in the UK specifically focusing on the primary healthcare needs and experiences of the young adult population. Previous quantitative studies have shown that young adults report more negative experiences with their healthcare providers in comparison to other age groups [34, 35], although reasons for this could not be explored. The data obtained from these interviews have contributed to filling the gap in knowledge about young adults’ perceptions of primary care and possible causes for lower rates of satisfaction with current services. Participants were from a range of ages and occupations, and reported a varied use of primary care services. Although the participants in this study were representative of the local population in terms of demographics, the sample does lack representation from ethnic minority and NEETs (not in employment, education or training) population groups. The views of young adults from these groups need to be explored in order to enrich our understanding of experiences of young adults in general.
Another limitation of this study was the lack of sufficient information about non-responders; we were unable to assess whether or not they had different characteristics from those who participated. The demographic details relating to our participants were diverse, however, and there was a wide range of experiences reported.