Getting an appointment to see a GP - case study learning about sustainable access systems

Problem

Difficulties getting GP appointments continue to dominate public and media discourse about patient (dis)satisfaction with the UK NHS, and with primary care. The GP workforce is shrinking, patient numbers and health needs are increasing, with the result that patients wait longer for appointments, causing commentators to question the sustainability of the UK model of general practice. Various systems to manage appointments have been developed and deployed in the UK and elsewhere. The Covid-19 pandemic added further disruption to the ways access was managed within practices. As we move to a ‘new normal’ post pandemic it is timely to examine the varied general practice access systems in use and how they are working for patients and practitioners.

Approach

Focused ethnographic case studies (observation, interviews and documentary analysis) in 8 English general practices that had at least three years’ experience (at least 18 months pre-pandemic) of the implementation of an ‘innovative’ access/appointment system, to explore how these systems work - in particular whether practices made adjustments and adaptations or if they abandoned previously introduced systems. Practices were purposively sampled, identified via consultation with professional and stakeholder advisor networks and informed by an earlier scoping review. Analysis has included individual and team coding, production of practice summaries to capture contextual information and key findings, and the development of a thematic coding structure.

Findings

We describe the different types of access systems in use in our case studies, the ways these were adapted, and use examples of the everyday interactional challenges encountered in “making an appointment” to understand how they are working from the perspective of both general practice staff and patients. Our analysis explores how access is accomplished (including rules and workarounds) and reveals points of tension and challenge, including the gaps between how the system purportedly ‘works’ and how it ‘feels’ for staff and patients.

Consequences

This research project is, to our knowledge, the first study that has revisited UK general practices that have previously been involved in research where a new access system was deployed and has been evaluated. Our study offers unique data building on earlier interventions designed to fix the problem of patient access. We explore what happened when these interventions were used during the Covid-19 pandemic and beyond. Our analyses provide transferable evidence to support and inform future learning about sustainable change in primary care practice and service delivery. It is time we learnt what happened to previous attempts to address the problem of access to inform lasting improvements to GP services.