Salisbury, Chris, Banks, Jon, Goodall, Stephen, Baxter, Helen, Montgomery, Alan, Pope, Catherine, Gerard, Karen, Simons, Lucy, Lattimer, Val, Sampson, Fiona, Pickin, Mark, Edwards, Sarah, Smith, Helen and Boudioni, Markella
An evaluation of advanced access in general practice
National Co-ordinating Centre for NHS Service Delivery and Organisation
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Aims: To evaluate ‘Advanced Access’ in general practice, and assess its impact on patients, practice organisation, activity, and staff.
To describe the range of strategies that general practices have employed to
improve access to care
To determine the impact of Advanced Access on the wait for an appointment,
continuity of care, practice workload, and demand on other NHS services. To explore the perceptions of different groups of patients, including both
users and non-users of services, about the accessibility of care and their
satisfaction with access to care in relation to different models of organisation.
To explore the trade-offs that patients make between speed of access,
continuity of care and other factors when making an appointment in general
To explore the perceptions of general practitioners and receptionists about
working with the NPDT and implementing changes to practice arrangements
to improve access.
To assess the impact of the above changes in practice organisation on staff
job satisfaction and team climate.
Method and results:
This research was based on a comparison of 48 general practices, half of
which operated Advanced Access appointment systems and half of which did
not (designated ‘control’ practices). These practices were recruited from 12
representative Primary Care Trusts (PCTs). From within these 48 practices,
eight (four Advanced Access and four control) were selected for in-depth case
study using an ethnographic approach.
The research was comprised of several component studies. These included:
• A survey of all practices in 12 PCTs. Based on this we recruited the 24
Advanced Access and 24 control practices and the 8 case study practices.
• An assessment of appointments available and patients seen, based on
• An assessment of continuity of care based on patients’ records
• Random phone calls to practices to assess ability to make an appointment
• A questionnaire survey of patients attending the practices
• A postal survey of patients who had not attended the surgery in the
previous 12 months
• A discrete choice experiment to explore trade-offs patients make between
access and other factors
• A survey of practice staff
• Qualitative case studies in 8 practices
• Interviews with PCT access facilitators
The methods and results for each of these studies are described below, in
relation to each of the research objectives.
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