Perspectives on access in primary care from patients, clinicians and practice staff: The PEOPLE-HULL study

Problem

Hull has one of the highest rates of lung cancer in England, but one of the lowest rates of two week wait referrals, indicating potential delays in diagnosis. The PEOPLE-Hull study combines public, community engagement and primary care interventions to improve early diagnosis of cancer. The current stage of the study focuses on a primary care intervention which is comprised of practice-specific media campaign, educational activities and quality improvement, fast-track appointments, focused ethnography, interviews, consensus development exercise and data extraction. We report on the interviews and ethnographic observations to explore potential barriers to help seeking in primary care.

Approach

We interviewed clinical staff and administrative staff (n=7) in the recruited GP practices and patients about potential barriers to appointments, patients were also asked about potential barriers to seeking treatment for respiratory symptoms. Eligible patients were adults over 50 years old (n=10), preferably without COVID, consulting for respiratory symptoms or who have developed new respiratory symptoms during the study period (when the practice-specific media campaign materials are being displayed). Administrative staff were invited to take part in focus groups. Interviews and focus groups were semi-structured and were conducted over the phone, face-to-face, or online after written and verbal consent was given. They were audio recorded and transcribed verbatim. Transcripts were analysed thematically and managed in NVivo. Additionally, four observations were carried out in each of the recruited practices, within the waiting area with patients and the main office area with practice staff.

Findings

Patients and staff at GP practices have contrasting opinions on the availability and type of appointments offered in practices. Staff at study sites reported that face-to-face appointments never stopped, and that they are offering as many appointments as possible, including extended access options. Patients however, believe that face-to-face appointments have become limited, and expressed some frustrations with the changes in booking systems and the increased emphasis on triaging. During the observations, patient frustration and anger was often directed at the practice staff on the phones, which was also raised by practice staff in the focus group discussions. Our data suggests that patients view staff as gatekeepers to care, and that this process of booking appointments can impact willingness to make appointments more than interactions with clinical staff.

Consequences

Data collection is still ongoing. Understanding how the change in appointment availability and booking systems act as a barrier to patients seeking help for respiratory symptoms will contribute to the development of targeted interventions to fast-track appointments. This in turn will potentially improve lung cancer outcomes.