Patient and professional experiences of access to general practice: a qualitative study informed by the Candidacy framework

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

8B.3

Presenter:

Evleen Price

Co-authors:

Evleen Price, Akbar Ansari, Katy Horder, Janet Willars, Jake Beech, Rebecca Fisher, Hugh Alderwick, Mary Dixon–Woods, Carol Sinnott

Author institutions:

THIS Institute Department of Primary Care and Public Health University of Cambridge,the Health Foundation

Problem

Much of the debate on access to general practice has focused on demand and supply of appointments. However, this conceptualisation of access may obscure the ways that people move through systems as “candidates” for care that are organisationally, culturally and professionally constructed. In this project we use the candidacy framework –which recognises access as a dynamic and contingent process – to explore patients’ and professionals’ experiences of access to general practice and to consider the possible impacts of different approaches to access.

Approach

Semi-structured qualitative interviews were offered online, by telephone or in-person with general practice staff (clinical and administrative) recruited through the East of England Clinical Research Network and with patients and carers recruited through five Healthwatch groups with an emphasis on diversity of age, gender, medical history and geographical location. Interview topic guides and analysis were informed by the Candidacy framework and focused on participants’ most recent access experiences.

Findings

Interviews were conducted with 41 patients and carers and 29 general practice staff. Early analysis has identified emerging themes on how changes to access arrangement influence multiple aspects of patient candidacy. Particularly consequential are increasing fragmentation of care within general practice, diversification of roles and skill-mix, and use of forms of remote care. These all impact on patients’ identification of themselves as candidates and on their ability to seek and ability to secure care, as well has influencing key features of quality general practice care (e.g. continuity). Analysis also suggests a distinction between “annoying” versus “unsafe” barriers to access and the consequences of demand arising from failures and delays elsewhere in the health and care system.

Consequences

The initial findings demonstrate the value of the candidacy framework in recognising that access is not a simple matter of demand and supply of appointments, but instead is subject to multiple influences and is wide-ranging in its impact. This is important in identifying and evaluating new strategies to improve access.

Submitted by:

Carol Sinnott

Funding acknowledgement:

CS, AA, EP, JW and MDW were supported by The Healthcare Improvement Studies (THIS) Institute. THIS Institute is supported by the Health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK.