In July we held our first online meeting with 12 stakeholders (including senior academics in primary care, clinical lecturers, representatives from NHS England and NHS Improvement, the Nuffield Trust and the Royal College of General Practitioners, leaders from Clinical Commissioning Groups, a practice manager and PPI representatives) to explore views and experiences of GP access.
Helen and Catherine welcomed everybody and provided a brief outline of the study which is revisiting approaches to improve access in general practice to see how these changed before, during and “post”-pandemic.
Early questions from stakeholders revolved firstly around definitions of access. Access can, for instance, be understood as obtaining an appointment with a health care provider or more simply as the first contact (e.g. a phone call to the practice). One stakeholder suggested that determining whether a service can actually be used by those who need was more important than how people try to access it. Participants agreed that the availability of appointments is just one of many factors that should be considered. This helped us to re-clarify that in our study we take access to mean a patient obtaining an appointment with a GP or other primary care clinician. This incorporates timeliness, physical access and choice – concerns which informed our research questions.
The meeting proceeded with a series of short presentations from Abi and Helen. First, Abi talked us through the initial work for our Scoping review of the research literature about different access and appointment systems that have been tried in General Practice. The conversation that followed captured how the question of access is entangled with other important questions and concerns. For instance, we talked about the relationship between access and clinical outcomes (our study is not measuring the latter). We also heard more about new networks and collaborations that practices are involved in, such as new primary care hubs, and how these may impact on access to and the provision of care. We talked about the many difficult methodological choices the team had to make to focus the review: we have tried to keep a tight focus on access.
Second, Helen outlined the models of access that the team has already identified:
- Triage (assessment by phone, online or email before offering an appointment)
- Restriction (limiting appointment availability, length or number of problems to be dealt with)
- Substitution (offering access to an appointment with a pharmacist or physiotherapist rather than GP)
- Alternatives to a face to face appointment (offering access to an appointment via a remote medium)
- A mix of these
The team plan to continue to refine this list and draw up a typology of models of improving access. This will help the selection of the practices for the next part of the study, and will also be useful to policy makers and researchers interested in this topic.
To explore stakeholder views about the different models of access we split up into three smaller groups to discuss the following questions:
- What models of access are you familiar with?
- Do they fit in the categories we have showed you?
- Is knowing the reason or rationale for a system of access important to you?
- What details about the modes or systems are most useful for you to know?
This elicited people’s experiences of access. One patient representative who has a hearing impairment explained the difficulty of getting an appointment for herself, and different barriers for others who she cares for. Stakeholders also illustrated the existence of unofficial or adaptive ways of gaining access, for example being allowed to text the GP to “get around the system”, and GPs told us how access ‘worked’ in their practices.
A final plenary session shared the learning from these smaller groups, and offered a preliminary ordering of models of access:
- digitally facilitated (e.g. use of e-consultation or online booking)
- ‘professionally mediated’ (e.g. appointments made for patients by pharmacists or the 111).
We are taking these ideas and comments forward to help us complete the scoping review and draft our typology ahead of a second stakeholder meeting scheduled for October 2022.
The programme presents independent research funded by the NIHR under its Health Services and Delivery Research funding scheme (NIHR133620). The views expressed in this blog are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.