Today, we’re speaking to Professor Helen Atherton. Helen is Professor of Primary Care Research based at the University of Southampton.

Title of paper: What do patients want from access to UK general practice?

Available at: https://doi.org/10.3399/BJGP.2024.0582

Widely accepted as perpetuated by the media is that patients are unhappy with access to general practice and desire faster access to a general practitioner. This review sought to summarise the research evidence about reported patient wants from access to general practice. Patients wanted to easily make an appointment in a timely fashion, to have a positive relationship with the practice, to see a specific clinician and choose consultation modality according to individual circumstance. Communication and being kept informed about access throughout the process of making and having an appointment, was something patients wanted, and this could be addressed by general practice.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00 .480 - 00:01:00 .150

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for listening to this podcast today.

In today's episode, we're speaking to Professor Helen Atherton.

Helen is professor of Primary Care Research based at the University of Southampton, and we've only just speaking to her recently on this podcast about the increasing digitalization of general practice. This time we're speaking to her about her recent paper here in the BJDP titled what Do Patients Want from Access to UK General Practice?

So, hi, Helen.

It's really nice to speak again about this area of research and I guess I just wanted to start by saying that access is such a loaded word and really, when it comes to general practice, it's part of a fairly negative media campaign against general practice. But it seems that this negative narrative just keeps getting pushed, despite lots of attempts to fix it.

So I just wonder if you could reflect on that.

Speaker B

00:01:00 .470 - 00:01:51 .950

Yeah, absolutely. So that the negative media coverage was one of the reasons that I wanted to do this review.

So this review was a bit of a labour of love because I had a feeling from the work that I was doing on digital access and other research that actually the reality was probably quite different, what we were seeing in the headlines and having looked into it, although there's lots of research out there on patient experience and satisfaction, we have a national survey that looks at that. There wasn't anything about what patients actually want. And so that kind of.

I thought, actually, wouldn't it be really interesting to find out from the evidence what they actually want and see if it does fit with the narrative we see in the papers and on social media. So, yes. So completely agree. And that was kind of where the idea came from, really.

Speaker A

00:01:52 .420 - 00:02:08 .180

Yeah.

And I just want to unpick what you really mean by access in this paper, because I think for some people it means, you know, just getting an appointment to see their GP within a day, but it can mean lots of different things to other people. So what did you conceptualize that as?

Speaker B

00:02:08 .740 - 00:02:49 .840

Well, it was difficult.

And you're right, there are lots of different definitions of access, and particularly in the research context, for us, we were interested in access to an appointment, so we were very focused on the processes that patient would go through in order to get the appointment, go to the appointment.

And we did go back and forth several times with this review because it was so difficult to define and there will be other researchers who use different definition, but because we were so interested in a lot of the kind of media narrative. It just felt like the best fit to look at access to an appointment with a gp.

Speaker A

00:02:50 .000 - 00:03:04 .540

So this paper was a systematic review and you looked at papers which explored different aspects of access. And I guess the big question here is, what did patients want in terms of access?

I wonder if you could just give sort of a headline summary and then we can talk a bit more in depth about it.

Speaker B

00:03:04 .780 - 00:03:56 .070

Sure. So what was interesting is I don't think their wants were particularly surprising or out of line with what general practice wants to deliver.

That's the first thing to say. And it was things like wanting to choose a clinician that they've seen before, if they.

If they've seen a clinician before, wanting to have choice around the skill mix. So which healthcare professional. They saw the consultation modality wanting to have a good relationship with the practice.

They wanted ease of booking and relatively speedy access. But not. There wasn't any evidence that people all wanted to be seen on the same day, which is maybe how the media narrative goes.

And there were also some things around wanting it to be easy to get to and having a nice waiting room. So really quite simple things as well.

Speaker A

00:03:56 .230 - 00:04:19 .350

I think choice is a really interesting area to explore.

So some people might not feel they have the right access if they get booked in, like you say with the gp, they don't know, or if they get booked in to see someone working in another clinical role in the practice.

But I wonder what you thought about the implications, given the increasing lack of continuity of care and this widening multidisciplinary team in practice.

Speaker B

00:04:19 .870 - 00:05:16 .510

Yeah. So it didn't escape our notice that a lot of what we were seeing was probably at odds with current policy around general practice.

The fact that patients fully understand that continuity of care is important at times, and there's lots of evidence that that is the case. And general practice, as a rule, tends to encourage that, I would say. And then also with the skill mix at odds with the idea that you.

You can kind of sub in other healthcare professionals as a way to tackle lack of capacity. Whereas I think patients are smarter than that and realise that sometimes it's appropriate, but other times it's not. Yeah.

And then also with the digital as well.

So, again, people wanting the choice, understanding that sometimes it's better to do things that way or more convenient, but not wanting to be forced down that route, which is kind of the way that we're going, really, in terms of policy for digital access.

Speaker A

00:05:16 .990 - 00:05:24 .830

And. Yeah, talk us through that.

What people thought about access in terms of the kind of consultation they got like a telephone or a face to face appointment.

Speaker B

00:05:24 .830 - 00:06:12 .650

Yeah. So patients were happy to have those types of consultation.

So when it came to use of remote consultations, patients were happy to do that where it met a need. So if they didn't want to come to the practice, they weren't able to.

Perhaps if they had a sensory disability, lots of reasons why they wanted to do it, but wanting to have the choice about how that happened, which was interesting. So people would say they didn't want to have to travel to the practice because it wasn't convenient.

This could be around work or childcare, or it might be that they had mobility issues, but there was generally a reason why they didn't want to be in the proximity of the general practice. And that's when remote consultations were what patients wanted.

Speaker A

00:06:13 .450 - 00:06:35 .840

Yeah, fair enough.

So it seems a lot of the time people just want a choice and I think it's interesting, particularly given the increase in a triage first approach in many practices.

But there was something you mentioned in the article that I thought was quite interesting, which was about co production with patients to solve access problems. Just tell us what you think this should look like.

Speaker B

00:06:36 .160 - 00:08:01 .890

So as well as doing this review, I'm involved in other research around access to general practice. And a big thing that we see happening is almost like a. Not a lack of communication, but a miscommunication between patients and practices.

You know, not intentional, nobody's trying to confuse the other, but patients perhaps not really understanding the access systems in place, not understanding what is available to them. If they don't have a choice, why they don't have a choice.

And so I think there's a lot of room for more kind of working together in terms of what that looks like. I think we have to be brave and ask patients what they want.

This is a systematic review, so it looks at existing evidence and most of those studies were not focused on looking at just what patient