By Emer Brangan
Centre for Academic Primary Care
and NIHR CLAHRC West
A&E departments in England have faced considerable pressure for several years, with high profile missed performance targets at several major A&E units last winter receiving widespread media coverage.
So how can GP practices help?
Our research suggests that investment in primary care reception staff, simplifying appointment systems and addressing patient perceptions of access could make a difference.
Our mixed methods study in England, funded by the NIHR School for Primary Care Research, is bringing together findings from a systematic review of the literature, multivariate analysis of routine data nationally, and six qualitative case studies in primary care practices. Drawing on the qualitative case studies we produced an animation (see below) of three short stories about access to primary care, told from a patient, primary care receptionist, and GP perspective.
We found that practices responding to high demand and a broad range of needs have designed complex appointment systems. These systems were not transparent for patients (and sometimes even staff), and seemed to contribute to inequitable access. In contrast A&E navigation is much simpler. GP practices need to aim for a system that is easier for patients to understand, and build in flexibility.
Many practices use telephone triage by clinicians to provide such flexibility, but this approach does not work for everyone. Skilled reception staff have an important role to play in delivering transparent, flexible and equitable access. The receptionist’s role in access often seemed to be overlooked or undervalued. Perhaps practice management and clinical staff need to experience the reception environment at its busiest? GP practices need to invest in and support reception staff who can act as crucial access facilitators.
We also found that if a patient’s past experience was that they couldn’t get the appointment they wanted then they are less likely to try again. Patient perceptions of access are just as important as actual access. Practices need to work on this as well as the system itself.
Working to create simpler, more understandable appointment systems, and investing in GP reception staff, might not only help create more equitable access to primary care services, but could also help tackle the long term problem of increasing A&E attendances.