Experiences of access to general practice in England: qualitative study and implications for the NHS 10-year plan

Why it matters

Access to general practice matters hugely to patients, but public satisfaction has fallen in recent years. Improving access features prominently in UK Government’s new 10 Year Health Plan for England. It aims to do this by, among other things, ‘re-imagining’ how care is delivered through three ‘shifts.’ 

• The first shift – to digital – includes an expanded NHS App positioned as the new digital ‘front door’, with patients able to book and manage appointments, self-refer to selected services, and access information about their health to support their own self-care.
• The second shift – to community – involves a move towards a neighbourhood-based approach to delivering services. This will mean GPs working with other health and social care staff in multi-disciplinary teams over much wider geographical areas, and new neighbourhood health centres operating as ‘one stop shops’.
• The third shift – to a more personalised and preventive health system – seeks to use technology, data, genomics (the study of genes and how they work together) and community resources to help in prevention.

All three shifts will affect access to general practice in England, including many alternatives to the traditional appointment with a GP.

We interviewed patients and carers from Devon, Medway, Blackpool, Luton, and Lancashire, and staff at NHS general practices in the East of England, to find out about their experiences and views of access to general practice. Many elements of the three shifts were already underway at the time when the interviews were conducted in 2023, so the findings offer significant insights into how people will experience access in light of proposals in the 10 Year Plan.

What we found

Views were mixed on all three shifts.

The shift to digital – for example in the form of online appointment booking systems – was seen as offering more convenience and efficiency for some. But digitalisation was also seen as creating risks that some groups, especially those already vulnerable, could be further disadvantaged. Digitalisation was also seen as failing to solve the deeper problem of a shortage of appointments with GPs and could de-humanise aspects of care.   

The second shift, from hospital to community-based services (with GPs working more closely with other staff and services over wider geographical areas), was also seen as offering some benefits. But concerns focused on the potential for fragmentation of care, increased burdens of coordination, and practical challenge.   

Finally, people recognised prevention activities as important in principle, but prone to fragmenting care, focusing too narrowly on single conditions, and taking up time and resources that could be used for patient-initiated contacts.

While improving access to general practice is one of the aims of the English NHS reforms, achieving that ambition is unlikely to be straightforward under current proposals. Much more clarity is needed about what the offer to patients is, and what “good enough” looks like in terms of access, along with careful co-design and evaluation of the detail of the three shifts.