Population, workforce, and organisational characteristics affecting appointment rates in primary care: a retrospective cross-sectional analysis

Problem

This study aims to identify the population, workforce, and organisational predictors of practice variations in appointmentvolume. Appointment volume and the waiting time for appointments are direct measures of patient access to primary care. The practice level appointment data was published by NHS Digital for the first time in November 2022. Previous studies had to rely on self-reported survey data as measures of access.

Approach

We conducted cross-sectional regression analysis using practice level appointment data collected from 6,284 GP practices in England in August to October 2022, to relate population age and deprivation, numbers of GPs, nurses and other care professionals, and organisation characteristics (e.g. practice rurality, contract type), to numbers of appointments by stafftype (GP or other practice staff) and to proportions of appointments took place on the same or next day after booking.

Findings

Appointment levels were higher at practices serving rural areas. Practices serving more deprivedpopulations had more appointments with other care professionals but not GPs. One additional fulltimeequivalent (FTE) GP per 1,000 patients was associated with an extra 175 appointments per1,000 population over three months. Additional FTEs of other staff types were associated with largerdifferences in appointment rates (367 appointments per additional nurse and 218 appointments peradditional other care professional). There was evidence of substitution between staff types inappointment provision. Levels of staffing were not associated with proportions of same or next dayappointments.

Consequences

Supply and demand predictors of variation in activity levels for all practices in England could not be identified until now. We show that appointment rates per person are higher for practices serving rural areas. Appointment rates with other care professionals are higher in deprived areas but appointment rates with GPs are not. This may indicate inequality in access to certain GP services. There is clear evidence of substitution between GPs and other care professionals in the provision of appointments. This may indicate that recent policy efforts such as The Additional Roles Reimbursement Scheme (ARRS) is effective.