Introduction

General practice is the cornerstone of NHS care, committed to providing comprehensive, coordinated, and continuous care across the lifespan for both acute and chronic conditions. Despite an increase in the number of appointments available, patient satisfaction with access to NHS general practice is dwindling. This decline reflects challenges such as difficulty in contacting practices, limited appointment choices, and restricted access to preferred professionals. Addressing these accessibility issues is crucial for enhancing patient experience and outcomes, as well as improving the working conditions of primary care staff.

Methodology

To tackle this pressing issue, a narrative systematic review was conducted to collate and thematise interventions aimed at improving access to NHS general practice from 1984 to 2023. Using the Candidacy Framework as a guide, which considers access as influenced by multiple factors arising from individuals, their social contexts, and available services, the review identified 449 relevant sources. These sources were categorised into six overarching thematic categories: appointment innovations, direct patient access to services, expanding the range of professionals, offering contacts beyond core hours and settings, supporting patient engagement, and supporting broader structures of general practice.

Findings

The review highlighted that the most frequently targeted aspect of access was 'permeability', or the ease with which people can utilise services. Interventions such as digital triage and expanded out-of-hours care were prevalent, though they sometimes posed challenges for certain groups, potentially reducing service permeability due to increased demands on personal resources like digital literacy.

Moreover, the review revealed a gap in addressing 'offers and resistance', which involves individuals' decisions to accept or refuse care offers. Enhancing patient engagement in consultations and shared decision-making emerged as critical areas needing further attention.

Discussion

The comprehensive catalogue of interventions provides a valuable resource for policymakers, researchers, and healthcare providers aiming to improve access to general practice. It underscores the importance of adopting a holistic approach to access, beyond merely increasing appointment supply. By addressing the broader influences on access through the Candidacy Framework, interventions can be better designed to meet diverse patient needs and enhance equity in healthcare provision.

Conclusion

The extensive efforts over the past four decades to improve access to general practice highlight both the complexity of the issue and the need for continued innovation. This curated catalogue offers a crucial foundation for future endeavours in enhancing access, with an emphasis on understanding the multifaceted nature of accessibility challenges. By learning from past interventions and focusing on more inclusive and patient-centred approaches, we can pave innovative paths in general practice that ensure equitable access for all.

Source: What’s been tried: a curated catalogue of efforts to improve access to general practice