New research highlights critical factors for inclusive primary care environments

New research has found that just 22% of disabled patients feel independent in health centre environments, whilst almost three quarters of people who support others feel more adjustments are necessary. These issues impact on the health outcomes for people who have disabilities.

Around 600 people took part in the ‘Building Better Together’ research conducted by learning disability and autism support provider, Dimensions. This was part of their #MyGPandMe project and the subsequent report covers experiences of people with physical disabilities and impairments, learning disabilities and autism in primary care buildings.

The report highlights that environmental stressors can result in heightened anxiety and missed appointment, with four key themes emerging:

  1. Independence, choice and control
  2. Dignity
  3. Feeling relaxed
  4. Patient care

Independence, choice and control

Healthcare buildings must not increase an individual’s dependence on others.

Signs, ramps, railings and doors were found to be of significant importance for disabled patients navigating the building, without needing more support than they would elsewhere.

In fact, only 18% of those who support someone felt the person can understand the signs in their surgery.

Only half of disabled people said they can understand the signs.

They also told Dimensions that automatic doors are essential to move around independently and reduce the need to rely on others.


Requiring assistance, lack of privacy and unsuitable toilet facilities can impact patient dignity.

Less than half of respondents felt toilet facilities in primary care met people’s needs and Changing Places facilities were highlighted as an important adjustment, where possible.

Respondents also cited high reception desks as a significant barrier to dignity, especially for people in wheelchairs. The distance between people can result in high-volume conversations about private health matters.

For many, anxiety from the undignified start leads to poorer outcomes from the appointment itself.

Feeling relaxed

Décor, lighting, noise levels and waiting room layout were all highlighted as factors that affect how people feel when visiting their healthcare building.

Environments can either be too clinical or too busy. Both create a stressful atmosphere with over a third of disabled respondents saying they felt stressed in their primary care setting and almost 45% felt worried.

Meanwhile, almost half of those who support people to go said they felt stressed and 55% think the person they support felt stressed.

Patient care

Environmental stressors are made worse when patient care isn’t supportive or respectful.

Respondents told Dimensions that the skills, knowledge, training and attitude of people working in primary care is important.

They explained that issues in their primary care building make it even more important that staff understand their needs and supporting their independence and dignity can help mitigate some of the negative environmental factors.

 The impact of covid-19

The global pandemic has seen healthcare provisions change overnight, proving that adjustments can be made quickly.

While some could remain permanent after the pandemic, they must be appropriate for everyone.

Respondents to the survey told Dimensions that in-person appointments are still very important and, while virtual consultations work for some people, they’re not well-suited for annual health checks or for people who do not communicate with words.

Supporting disability access

Dimensions and Assura PLC are working together to provide support for existing and new primary care facilities to be more accessible and adaptive. They are calling for the national disability strategy to reflect this and help improve healthcare facilities nationally.

Dimensions Quality Checker, Ann McCallum, said:

“At the moment, there are people who need to get to their surgery, but they can’t because of reasons that are beyond their control.

“I know from personal experience that people can get a fear of doctor’s surgeries and hospitals – but I know that if those places could get things right for me, then I might be a bit more forthcoming.

“There will always be some fear, of not knowing what the tests results will say or how things will go, but it can get blown out of proportion when the whole process is difficult, from making that initial phone call, through to attending an appointment.

“I think the relationship between patients and their doctor is really important, but you need time to build it and it’s a lot easier when you are more relaxed.”

Dimensions CEO, Steve Scown, said:

“This report marks an exciting new phase in the work Dimensions has led to support better outcomes for people who have a learning disability and autism in primary care. The buildings in which we all access healthcare can both help and hinder our engagement with health services and, as this report shows, it is vital that primary care buildings meet the needs of all patients.”

Assura PLC CEO, Jonathan Murphy, said:

“Our experiences of primary care buildings can have a real impact on our perceptions of care and on willingness to engage with local health services at all – and this report shows just how varied those experiences can be. The way we design and improve health spaces in our communities can play an important part in reducing health inequalities, and the learnings from Building Better Together show the scale of the change that is needed.”

About the research

The research into disability access at primary healthcare facilities was commissioned and supported by healthcare property business Assura. It is part of the Dimensions #MyGPandMe campaign to make healthcare accessible for people with learning disabilities and autism.

Around 600 people responded across an online survey and focus groups. This research was done before the pandemic and subsequent research adhered to social distancing guidelines.

Further data and statistics are available on request.

The full report and an easy read version is available to download at

About Dimensions

Dimensions provides evidence-based, outcomes-focused support for people with learning disabilities, autism and complex needs. We help people be actively involved in their communities.

We are one of the largest not-for-profit support providers in the UK. We currently support around 3,500 people and their families throughout England and Wales with help from our 7,000 members of staff.

We have been providing support packages for families for 40 years. We offer a range of support services to adults of all ages, including those with complex needs or challenging behaviour.

We are proud to be a not-for-profit organisation, not here for commercial gain. This means we’re able to invest all our efforts and resources into the important things – which is helping the people we support lead happy and fulfilled lives. | @DimensionsUK

About Assura PLC

Assura is a real estate investment trust and long term property partner to more than 570 primary care buildings across the country, in which more than 500 GP practices operate and from which more than five million patients are served. The Assura Community Fund is supporting health-improving projects in the communities surrounding those buildings. | @assuraplc

Download and share the report

We encourage you to read and share the full report. The more people in the health and social care sectors understand how important it is, the more steps they can take to become learning disability and autism friendly.

Join in the conversation on Twitter using #MyGPandMe