Implementing Change to Improve Access in UK General Practice: A Mixed-methods Exploratory Case Study.
Access to general practice is often stated by politicians as an issue the public are concerned about - it is a complex issue that requires multiple interventions in order to address different aspects of the problem. There are three main dimensions of access: availability and proximity of care, timeliness of care, and ability to see their preferred GP or nurse. Across the UK, GP practices are testing diverse approaches to improve patient access to their services, while under financial and workload pressure. There is a lack of evidence around what does and doesn’t work, how and why. Implementing any kind of change within the NHS is challenging. The objective of this study was to explore how general practices implement change to improve access and understand ‘complex’ change processes, by focusing on the role of context.
A mixed-methods study was undertaken in three general practices across two Clinical Commissioning Groups in England. Cases were selected to provide diversity. A focused ethnography was conducted in a number of settings, which included: waiting rooms, administrative offices, behind reception counters, various staff and clinical meetings and service development meeting. Transcripts of observations and informal and formal interviews with key stakeholders, as well as relevant documentary evidence (e.g. meeting minutes, reports, GP/ nurse rosters) were analysed thematically to explore aspects of context that influence implementation of a number of access initiatives. Relevant data were extracted from the National GP Patient Survey between January 2007 and 2016 to describe patient experience related to access (e.g. questions related to use of online services, experience of appointment making and preferred GP), at practice- and CCG-level.
Data collection and analysis are on-going. Preliminary analysis suggests the three GP practices have adopted different approaches to improving access, e.g. variations in appointment structure, online services (e.g. online booking system, online prescription requests, use of social media), telephone services and Named GP scheme (allocating and informing patients). Many of these ‘interventions’ evolve over time to meet the changes in local context (demand-led) and policy. This presentation will focus on the provision of services online. Recurring themes include competing priorities, resource management and team structure/ functions, what is expected of reception staff (what they should/shouldn’t do), practice manager role, practice history and level of patient involvement. Data will be presented on the characteristics of included practices; data from field notes of observations, documents and semi-structured interviews with staff; and data from the Patient Survey.
This mixed-methods study provides insights into the complexity and challenges involved in implementing and delivering 'access' initiatives, alongside the service commitment in general practices, in the context of the ever changing landscape of health care policy.