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Primary care

Identifying operational failures in general practice


Whether it’s searching for a missing piece of equipment or tracking down a colleague, even short disruptions during the workday can add up to significant losses in time. And for busy general practitioners (GP), unnecessary disruptions and system defects can steal precious time that could be spent with patients.

GPs are the first healthcare contact for most people in the UK. They diagnose, monitor and manage diseases, and work to prevent illness. They are cornerstones of the NHS, and they’re under increased pressure in recent years as demand for their services increases and healthcare resources decrease. It’s important that GPs can make the best use of their limited time, and aren’t weighed down by interruptions resulting from failures in the health system.

Previous studies have shown that hospital staff lose as much as 10% of their working time to interruptions and ‘operational failures’. So what about general practice? What sort of avoidable disruptions do GPs encounter, and can these operational failures be addressed?


This study looks at what GPs do in an average day to see what interruptions get in the way of their work, and which of these are caused by operational failures. The first three phases of work, involving a review of the literature, an interview study, and an observation study, are now complete. Phase 4, an online consensus building exercise, is currently in progress and expected to be complete by the end of 2021. You can read about the previous phases here:

  • Phase 1: An extensive review of the literature about the work GPs do in a day, and the time they spend resolving operational failures. Read about our findings here.
  • Phase 2: We interviewed GPs about the interruptions that interfere with their daily tasks, and tried to understand the nature and sources of these issues. Learn more about our findings here.
  • Phase 3: We spent time in surgeries observing GPs to assess the number and type of operational failures they encountered and the amount of time this consumed. Read about our findings here.

In Phase 4, we will host a series of online surveys with GPs, patients and quality improvement experts using our online research platform Thiscovery. We will ask participants to rate a range of operational failures, identified from the previous phases of the study, and aim to build consensus on:

  • Which operational failures are most important to prioritise for improvement, and

    how easy would it be to fix them.

  • How could they be fixed.

This will help us plan future research aimed at creating evidence-based improvement interventions.

The next stage of the work will examine how we can improve access to primary care.

Our research has highlighted frustrations among healthcare professionals and patients relating to the systems in place for accessing general practice care. Problems with accessing general practice can lead to negative consequences for patients, and poor experiences of work for primary care professionals.

A lot of the debate around access has tended to focus on demand for and supply of appointments – particularly in-person GP appointments. People also report difficulties in seeing their preferred healthcare professional. Improving access to primary care will help us to better understand some of the issues around access to general practice, and how it can be improved.

Funding and ethics

This study is funded by the Health Foundation’s grant to The Healthcare Improvement Studies Institute (THIS Institute). It is independently led by THIS Institute. The study was reviewed by the London Central Research Ethics Committee.

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