How do patients view access to primary care since the start of the Covid-19 pandemic? A qualitative study

Problem

Primary care is a key gateway to healthcare and access is of vital importance. Access to primary care is also a political issue and seen as a marker of performance for the NHS. In the early days of the pandemic, general practices switched to an online / telephone first approach to primary care, and many restricted physical access to their premises. For patients, this was a rapid and significant change to their experience of accessing care. Access to general practice has continued to change, in different ways in different places. As part of a larger study, we aimed to investigate patient’s experience of access, their view of this since the start of the Covid-19 pandemic and how it may impact health inequalities.

Approach

Qualitative semi-structured interviews and focus groups were used to explore 45 patients’ experience of access to primary care (December 2021 – August 2022) in one area of Greater Manchester. Participants were recruited from Patient Participation Groups (N=6) and underserved populations (N=39), including people from ethnic minority groups with Limited English Proficiency, people with mental health conditions and people with developmental / learning disabilities. Using a rapid approach to qualitative analysis, summaries of transcripts were produced and themes identified. A community-based research team (including patients and patient representatives, healthcare staff and policymakers) supported recruitment, data collection and analysis.

Findings

When talking about access, patients focused on the challenge of getting an appointment: the difficulty in following practice systems (phoning first thing or completing online forms) and their frustration when these attempts ended in failure (no appointments left or no response). Patients from underserved groups reported a preference for face-to-face interactions, finding it easier to communicate in-person and experiencing these interactions as more personal and caring. Not being able to get an appointment or see people face-to-face led to some losing trust in healthcare services. Older people in particular reported feeling abandoned and de-motivated to engage with their practice. Although some patients expressed empathy for staff, acknowledging their increased workload - including as a consequence of Covid-19, there was a sense that the pandemic was being used as an excuse and things should have gone back to ‘normal’.

Consequences

Systems for accessing primary care, including the changes introduced in response to the Covid-19 pandemic, create not just physical but inter-personal distance between patients and staff, and have the potential to reinforce and further embed inequalities. These systems need to be reviewed from the perspective of patients and staff to find ways to reduce this distance and increase equity in the context of systemic pressures. Findings from this project will inform the development of a resource set to enable this and optimise access to primary care for all.