Improving access to primary care
Issues around access to general practice care have become increasingly high profile. Our previous research has highlighted frustrations amongst healthcare professionals and patients which relate to systems for accessing general practice care, and difficulties with accessing general practice can lead to negative consequences for patients along with poor experiences of work for primary care professionals.
Much of the debate around access to general practice focuses on supply of, and demand for, appointments – particularly in-person appointments with GPs. People also report difficulties in seeing their preferred healthcare professional.
Evidence shows that access to high quality healthcare services isn’t just about whether, or how quickly, patients can get an appointment, though. People also care about who their appointment is with, whether it is in-person or remote (email or telephone), their continuity of care, and whether appointments are long enough to meet patients’ needs. Limiting discussion of access problems to a matter of demand and supply also limits the conversation around the broader range of influences on access, preferences and options for improving access, and the consequences of different options.
We want to gain a deeper understanding of the issues relating to access to general practice and how it can be improved. We will look at the ways general practice is accessed in a broad sense, using the candidacy framework which explores ways in which patients identify themselves as candidates for general practice care, how they navigate new systems (including remote consultations) and how consultations can be set up to best to support patients with multiple needs.
The Candidacy framework
The candidacy framework was developed to provide a holistic perspective on access to care by analysing how people identify themselves as candidates for healthcare. The framework is characterised by seven features: identification of candidacy, navigation, permeability of services, appearances at health services, adjudications, offers and resistance, and operating conditions.
The project will draw on the candidacy framework to inform a deeper exploration of the issues relating to access to general practice care, and how policymakers might best address these issues. It will involve developing a ‘CandidacyGP+’ framework, tailored for general practice.
The programme will involve four work packages:
- First, through a scoping review, we will develop an initial CandidacyGP+ framework that accounts for the distinctive features of accessing general practice.
- Second, we will develop a long list of solutions that have been tried, are ongoing or have been suggested for improving access to general practice.
- The third work package will involve refining the initial CandidacyGP+ framework through extensive consultation with patients and general practice staff.
- Finally, using an online survey of health care professionals, patients and policymakers, options for improving access using the CandidacyGP+ framework will be selected and prioritised.
- The project involves several stages and is expected to run from August 2022 to June 2024.
Funding and ethics
This study is funded by the Health Foundation’s grant to The Healthcare Improvement Studies Institute (THIS Institute). It is being jointly led by THIS Institute and the Health Foundation. The project is also supported by the Health Foundation policy team, RAND Europe, Healthwatch, and the East of England NIHR CRN. The study was reviewed by the London Central Research Ethics Committee.