Access to General Practice: Which systems have been tried? – A Scoping Review

Problem

Access to GP appointments is becoming increasingly challenging in many high-income countries, with an overstretched workforce and rising patient demand. Various systems to manage demand have been developed and evaluated in the UK and elsewhere. The Covid-19 pandemic saw disruption of established approaches within practices. It is timely to examine the varied general practice access systems that have been studied and to describe their components and the rationales behind them. This scoping review aimed to systematically consolidate and understand the current international evidence base related to different types of GP access systems.

Approach

Literature searches were run across relevant databases in May 2022. Title, abstract and full text screening was carried out for each reference independently by two researchers. Data from included studies were extracted, collated and mapped to synthesise and represent the types of GP access systems, their components and aims.

Findings

After screening 11,326 records, 49 studies were included in the review. The majority of these were set in the UK. Some access systems featured heavily in the literature, such as Advanced Access, telephone triage and online consultations, and others less so. There were two key strategies adopted by systems which related to either changing appointment capacity or modifying patient pathways. Components related to these strategies are summarised and illustrated as a schematic representation in the paper. Most rationales behind access systems were practice-focused (e.g., reducing GP workload, managing demand) rather than patient-focused. ‘Add on’ systems and aims for efficiency became more popular in recent years, reflecting the advent of digital alternatives and recognition of efficiency in appointment allocation as an approach to manage demand.

Consequences

This scoping review provides a comprehensive synthesis of the various components that make up GP access systems. Most of the studies included were set in the UK, reflecting a strong field of academic primary care research. This makes the findings particularly relevant and applicable to current day British general practice and the challenges of access, whilst being potentially transferable elsewhere. The synthesis and schematic representation provide a useful tool for GPs, academics, policy makers and patients interested in understanding more about access systems’ aims, design, and implementation, as well as offering a comparison tool to identify gaps in the evidence base. Patient-focused outcomes appear to be under investigated and therefore are at danger of being overlooked in the design and implementation of such systems. In recent years, digital services have been promoted as offering patient choice and convenience. However, this rhetoric contrasts with those access systems that aim to alleviate increasing demand by limiting appointment availability. A context where demand outweighs resources challenges the premise that extending choice is possible, without significantly more GP resource.