Agreeing access policy in a general medical practice: a case study using QPID

Liddell, W.G. and Powell, J.H. (2004) Agreeing access policy in a general medical practice: a case study using QPID. System Dynamic Review, 20 (1), 49-73. (doi:10.1002/sdr.283).

Abstract

The UK National Health Service (NHS) Plan has focused attention on the need to improve patient access to general practice. In trying to achieve the targets set for access, general practitioners (GPs) encounter a number of managerial dilemmas. For example, consultation times need to be limited, but the needs of individual patients for immediate care are unpredictable; continuity of care is highly valued, but GPs must be released for administration, training and other duties; delegation of tasks to other healthworkers can improve access, but dictates the need for training and the definition of legal and ethical responsibility. The management of access in general practice involves a number of constituencies including doctors, nurses, reception staff and, not least, patients themselves. Access to general practice constitutes a hybrid system, having some components that can be objectively viewed and quantified and others that remain qualitative, either because they are subjective by nature (e.g., morale and professionalism) or because data on that facet of the operation is simply not available. Hybrid management problems are amenable to treatment by qualitative systems methods and this paper describes an ex ante, real-life intervention using a qualitative system dynamics approach known as QPID (Qualitative Politicised Influence Diagrams). The method ascribes agents and actors to the connections in an influence diagram of the system under consideration. This process structures thinking about the appropriate actions (aimed at these agents and actors) for managing the system behaviour. The method is applied to the process of developing patient access policies for a large NHS practice in the South of England. It demonstrates the use of QPID to derive practical action plans for the management of this challenging aspect of general practice.

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