Carol Sinnott, Evleen Price, Akbar Ansari, Rebecca Fisher, Jake Beech, Hugh Alderwick and Mary Dixon-Woods. BJGP Open 9 January 2025; BJGPO.2024.0184. DOI: https://doi.org/10.3399/BJGPO.2024.0184
What’s been tried: A curated catalogue of efforts to improve access to general practice
Background
General practice is at the heart of NHS care and is expected to provide lifelong care that is comprehensive, coordinated and continuous, for both acute and long-term conditions. Meeting these responsibilities means making sure that patients have consistent and accessible ways into general practice. However, even though more appointments are being provided than ever before, patient satisfaction with access to NHS general practice is declining.
Improving access to general practice has been an important priority both in policy and practice for many years. Like others before it, the UK Labour government has committed to improving access to GP appointments. Although there have been reviews and attempts to improve access in the past, these have generally been narrowly focused and have not been systematically documented.
We’ve attempted to address that gap with a review which comprehensively organises the interventions which have been used to improve access to NHS general practice over the last 40 years, organises these interventions into categories and assesses which aspects of access are targeted using an approach for understanding access known as the candidacy framework.
The candidacy framework describes how people’s eligibility for healthcare is continually being negotiated and is subject to multiple influences arising both people and their social contexts, and the larger forces that influence how resources are allocated and services are organised.
Key findings
This review includes 449 relevant sources reporting on interventions to improve access to general practice over the period 1984-2023. It offers a comprehensive, thematically curated catalogue of attempts to improve access to general practice.
We used these sources to develop six overarching themed categories:
- Appointment innovations
- Direct patient access to services
- Increasing the number and range of professionals available to see patients within general practice
- Offering contacts beyond core hours, core settings and core services
- Supporting patient engagement, empowerment, and education
- Supporting the internal and wider structures of general practice
Most interventions addressed the candidacy feature “permeability” (the ease with which people can use services), and there was less emphasis on aspects of the access relating to the healthcare encounter itself or how people identify themselves as candidates for healthcare.
Patients attend general practice on an ongoing basis. Some attend multiple times per year, while others need to attend less frequently. Shifting the focus away from just making services faster to access to understanding how and why patients decide to seek care, how decisions are made and shared during healthcare appointments, and how their questions and concerns are handled may help to provide care experiences that leave patients feeling more satisfied.
This more holistic approach to understanding access could help identify where improvements to access are most needed, to understand why previous attempts have not had as much impact as was hoped, and to find different solutions, including those that promote equity.
Our review has produced a comprehensive catalogue of the many attempts that have been made to improve access to general practice in the UK over more than 40 years, guided by a framework for understanding access to healthcare that considers the entire patient journey and the influences on it. Organising these attempts into themes adds to the value of the catalogue for policymakers, researchers, clinicians and others.
These findings have considerable value in informing future efforts, especially those of the UK’s new government, to improve access and patient experiences of access to general practice.