An evaluation of advanced access in general practice

Abstract

Aims: To evaluate ‘Advanced Access’ in general practice, and assess its impact on patients, practice organisation, activity, and staff.<br/>Objectives:\nTo describe the range of strategies that general practices have employed to\nimprove access to care\nTo determine the impact of Advanced Access on the wait for an appointment,\ncontinuity of care, practice workload, and demand on other NHS services. To explore the perceptions of different groups of patients, including both\nusers and non-users of services, about the accessibility of care and their\nsatisfaction with access to care in relation to different models of organisation.\nTo explore the trade-offs that patients make between speed of access,\ncontinuity of care and other factors when making an appointment in general\npractice.\nTo explore the perceptions of general practitioners and receptionists about\nworking with the NPDT and implementing changes to practice arrangements\nto improve access.\nTo assess the impact of the above changes in practice organisation on staff\njob satisfaction and team climate.<br/>Method and results:\nThis research was based on a comparison of 48 general practices, half of\nwhich operated Advanced Access appointment systems and half of which did\nnot (designated ‘control’ practices). These practices were recruited from 12\nrepresentative Primary Care Trusts (PCTs). From within these 48 practices,\neight (four Advanced Access and four control) were selected for in-depth case\nstudy using an ethnographic approach.\nThe research was comprised of several component studies. These included:\n• A survey of all practices in 12 PCTs. Based on this we recruited the 24\nAdvanced Access and 24 control practices and the 8 case study practices.\n• An assessment of appointments available and patients seen, based on\nappointments records\n• An assessment of continuity of care based on patients’ records\n• Random phone calls to practices to assess ability to make an appointment\nby telephone\n• A questionnaire survey of patients attending the practices\n• A postal survey of patients who had not attended the surgery in the\nprevious 12 months\n• A discrete choice experiment to explore trade-offs patients make between\naccess and other factors\n• A survey of practice staff\n• Qualitative case studies in 8 practices\n• Interviews with PCT access facilitators\nThe methods and results for each of these studies are described below, in\nrelation to each of the research objectives.<br/>