Has the NHS national extended access scheme delivered its policy aims? A case study of two large scale extended access providers

Why it matters

Workforce issues and growing patient demand mean there are problems with patients being able to access primary care in England. In an effort to improve access, in 2013 the Prime Minister’s Challenge Fund was set up to provide funding to enable the extension of the hours that GP appointments are available.

In 2018, this scheme was expanded to cover the entire population of England. The ‘extended access’ policy mandated that all patients in England should be able to access general practice services outside of regular working hours. Often patients accessing these additional appointments are seen in a different location and by a different primary care team.

Approach

Existing research into the extended access policy has not investigated how access is operationalised, which makes it difficult to understand and interpret outcomes. This latest research explored the mechanisms of extended access and whether the policy aims and objectives are being met.

The research centred on case studies of two contrasting providers of extended access. Data were collected by THIS Fellow Patrick Burch and included 30 hours of clinician-patient observations, 25 interviews with staff, managers and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data.

Project findings

Three cross-cutting themes were identified:

1. Extended access is being used to bolster a struggling primary care system. The original aim of the extended access policy was to provide patients with more convenient access to general practice. This study suggests that the policy is only partially meeting its aims. It found that the main reason patients choose an extended access appointment is a lack of capacity at their registered practice, rather than because the appointments are more convenient. This highlights the practical difficulties of trying to implement policies aimed at increasing patient choice in an overburdened health service.
   
   
2. Extended access provides a different service to in-hours general practice. There was found to be an awareness among those involved in commissioning and designing extended access services that these appointments were not the same as having an appointment within the regular practice and would not be ideal for certain types of patients. The results of this study suggest that extended access does not offer the full experience of personalised general practice care. It can deal effectively with patients with straightforward issues, but can struggle to deal with patients with more complex needs who require ongoing care.
   
   
3. It is difficult for extended access to provide seamless care. The extended access policy specifies that extended access services must integrate fully with other NHS services. This study found that despite generally having access to patients’ medical records, extended access clinicians often struggled to provide joined-up, seamless care to patients who required follow up or further care after their initial appointment. This was partly due to extended access being a service designed for one-off encounters, but also due to clinician behaviour and limitations in the co-ordination mechanisms between extended access and in-hours practices.

In conclusion, this research has shown that extended access models may have a role to play in improving access for patients who need care for straightforward issues, but when there are more complex issues, this model of care can be problematic.