Access to General Practice: Innovation, Impact and sustainable change
Research type
Research Study
Full title
Whatever happened to all those attempts to change access to General Practice? Revisiting case studies to learn about innovation, impact and SUStainable change. (GP SUS)
IRAS ID
312590
Contact name
Catherine Pope
Contact email
Sponsor organisation
Research governance, ethics and assurance
Clinicaltrials.gov Identifier
researchregistry7588, Research Registry
Duration of Study in the UK
1 years, 8 months, 31 days
Research summary
Research Summary:
For decades there have been attempts to make new systems for timely access to appointments at the general practice, including offering online consultations, pre-consultation telephone calls or completion of an online form. During the 2020/21 pandemic many practices changed the way patients consulted with GPs and practice staff, using telephone and video consultations rather than face-to-face appointments.
We are asking: what happened after practices introduced changes to patient access? Did the systems work or did they need adjustments? Were there safety concerns? Did they change again in the pandemic? What might be learned from them to better serve patients in general practice in the long term? We have discussed this study widely and know these questions matter to patients as well as practice staff and policy makers. A public reviewer commented that access to appointments is THE most pressing issue facing general practice.
The aim of the study is to support lasting improvements that work for everyone. We will start by looking at all the different models of access that have been used, looking at all the published research and talking to doctors, patients, researchers and policymakers. We will then work with eight different general practices in England to learn as much as we can about the different systems they use, how and why they have been adapted locally and what they learnt about their system during the pandemic. We will compare these cases with the findings from a case study conducted separately by our collaborators in Copenhagen to see what we might learn for the UK from their experience. We will work with patients, the public and other stakeholders, to create resources that support changes for a truly patient centred general practice.Summary of Results:
Getting a General Practitioner appointment was described by our PPI advisors as the single most important issue for patients. Access is a concern for policymakers, healthcare staff and the public. General practices have tried different ways of allocating appointments and deciding how urgent different requests are. Some access systems have been tested in research studies, but this has not identified what works best.
We read the published research and talked to doctors, patients, researchers and policymakers to learn what had been tried in the past. Then we worked with eight general practices in England to learn about the appointment systems they used, and how and why these systems were adapted locally. We compared our English practices with a practice in Denmark to see what we might learn. We brought the learning together in a series of workshops to design resources to support improvements in access to appointments.
Access can be managed in two ways, by changing how patients get an appointment (for example seeing if they really need an appointment, or sending them to see someone who is not a GP) or by changing how many, or the kinds of appointments are available. That seems simple but it is not. We made a map of the complicated, different types of ways that practices try to manage how patients get an appointment. When we studied what practices did, we found that patients and practice staff have very different experiences and understandings of how access systems ‘work’. Many systems appear to make getting an appointment difficult for the patient, putting barriers in their way or making them ‘go round in circles’ before they get to see a GP. We found that practices constantly tweak and adapt access approaches using trial and error-based learning about what works for them. We also showed how important reception staff are in shaping and delivering access.
We suggest that rather than looking for one-size-fits-all solutions to the access problem we could encourage learning and knowledge sharing between general practices, to support adaptation and tailoring systems to meet the needs of their patients.
REC name
South Central - Hampshire A Research Ethics Committee
REC reference
22/SC/0333
Date of REC Opinion
14 Oct 2022
REC opinion
Further Information Favourable Opinion