An evaluation of advanced access in general practice

Aims: To evaluate ‘Advanced Access’ in general practice, and assess its impact on patients, practice organisation, activity, and staff.Objectives: 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 practice. 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 appointments records • An assessment of continuity of care based on patients’ records • Random phone calls to practices to assess ability to make an appointment by telephone • 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.<br/

The multiple sclerosis risk sharing scheme monitoring study - early results and lessons for the future

Background: Risk sharing schemes represent an innovative and important approach to the problems of rationing and achieving cost-effectiveness in high cost or controversial health interventions. This study aimed to assess the feasibility of risk sharing schemes, looking at long term clinical outcomes, to determine the price at which high cost treatments would be acceptable to the NHS. Methods: This case study of the first NHS risk sharing scheme, a long term prospective cohort study of beta interferon and glatiramer acetate in multiple sclerosis ( MS) patients in 71 specialist MS centres in UK NHS hospitals, recruited adults with relapsing forms of MS, meeting Association of British Neurologists (ABN) criteria for disease modifying therapy. Outcome measures were: success of recruitment and follow up over the first three years, analysis of baseline and initial follow up data and the prospect of estimating the long term cost-effectiveness of these treatments. Results: Centres consented 5560 patients. Of the 4240 patients who had been in the study for a least one year, annual review data were available for 3730 (88.0%). Of the patients who had been in the study for at least two years and three years, subsequent annual review data were available for 2055 (78.5%) and 265 (71.8%) patients respectively. Baseline characteristics and a small but statistically significant progression of disease were similar to those reported in previous pivotal studies. Conclusion: Successful recruitment, follow up and early data analysis suggest that risk sharing schemes should be able to deliver their objectives. However, important issues of analysis, and political and commercial conflicts of interest still need to be addressed

Impact of same-day appointments on patient satisfaction with general practice appointment systems

Following recent concerns about patients' inability to book appointments in advance, this study examined the relationship between the proportion of GP appointments reserved for same-day booking, and patient satisfaction with appointment systems. In a survey of 12 825 patients in 47 practices, it was found that a 10% increase in the proportion of same-day appointments was associated with an 8% reduction in the proportion of patients satisfied. Practices should be wary of increasing the level of same-day appointments to meet access targets

Implementation of Advanced Access in general practice: postal survey of practices

Background: Advanced Access has been strongly promoted as a means of improving access to general practice. Key principles include measuring demand, matching capacity to demand, managing demand in different ways and having contingency plans. Although not advocated by Advanced Access, some practices have also restricted availability of pre-booked appointments. Aim: This study compares the strategies used to improve access by practices which do or do not operate Advanced Access. Design of study: Postal survey of practices. Setting: Three hundred and ninety-one practices in 12 primary care trusts. Method: Questionnaires were posted to practice managers to collect data on practice characteristics, supply and demand of appointments, strategies employed to manage demand, and use of Advanced Access. Results: Two hundred and forty-five from 391 (63%) practices returned a questionnaire and 162/241(67%) claimed to be using Advanced Access. There were few differences between characteristics of practices operating Advanced Access or not. Both types of practice had introduced a wide range of measures to improve access. The proportion of doctors' appointments only available for booking on the same day was higher in Advanced Access practices (40 versus 16%, difference = 24%. 95% CI = 16% to 32%). Less than half the practices claiming to operate Advanced Access ((63/140; 45%) used all four of this model's key principles. Conclusion: The majority of practices in this sample claim to have introduced Advanced Access, but the degree of implementation is very variable. Advanced Access practices use more initiatives to measure and improve access than non-Advanced Access practices. © British Journal of General Practice

Notes from a small island: researching organisational behaviour in healthcare from a UK perspective.

This paper considers the development of research in organisational behaviour within the UK healthcare system since its foundation in 1948. It looks at the location and context of such work, given the unique setting provided in this national organisation. Contextual barriers that are both historical, political ontological and epistemological, are considered in the light of recent research developments in both academia, notably the bienniel international conference Organisational Behaviour in Healthcare (OBHC), where a search for comparative work has engaged with both the wider organisational and international communities, and government, notably the National Service Delivery and Organisation Research Programme. Confounding much of this is the absence of a way of understanding the complexity of the domain of healthcare in different contexts. The application of the Cynefin framework is then discussed as a way to aid understanding of both the organisational and research tasks, and to provide a forum for collaborative understanding to allow appropriate research and practice interventions to occur. Copyright © 2006 John Wiley & Sons, Ltd