Improving access to primary care (IMPRESS)

Access to general practice care is a growing concern for the public and policymakers. Many patients report difficulties getting appointments in a timely way, and in seeing their preferred health care professional when they do attend. These difficulties can have negative consequences for both staff and patients.

Much of the debate around access to general practice is focused on supply of, and demand for, appointments – particularly in-person appointments with GPs. But evidence shows that access to high quality health care services is a much more nuanced issue and includes not just how quickly patients can get an appointment, but who it is with, whether it is in-person or a telephone appointment, continuity of care, and whether appointments are long enough to meet patients’ needs. Policymakers have to take all of these into account when implementing measures to improve access.  

The candidacy framework

The candidacy framework was developed to provide a holistic perspective on access to health care by analysing how people identify themselves as ‘candidates’ for health care. The framework is characterised by seven features: identification of candidacy, navigation, permeability of services, appearances at health services, adjudications, offers and resistance, and operating conditions.

The IMPRESS research project will draw on the candidacy framework to inform a deeper and more holistic exploration of the issues relating to access to general practice care, and how policymakers might best address these issues. It will involve developing a ‘CandidacyGP+’ framework, tailored for the general practice. 

Approach

The programme will involve four work packages:

• First, through a scoping review, the research team will develop an initial CandidacyGP+ framework that accounts for the distinctive features of accessing general practice. 
• Second, the team will develop a long list of solutions that have been tried, are ongoing or have been suggested for improving access to general practice.
• The third work package will involve refining the initial CandidacyGP+ framework through extensive consultation with patients and general practice staff. 
• Finally, using an online survey of health care professionals, patients and policymakers, options for improving access using the CandidacyGP+ framework will be selected and prioritised.

Resources

Dixon-Woods M, Cavers D, Agarwal S, et al. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC medical research methodology 2006;6:35. doi: 10.1186/1471-2288-6-35. https://pubmed.ncbi.nlm.nih.gov/16872487/ 

Contact 

For more information, please contact: Professor Mary Dixon-Woods, Director at THIS Institute or Dr Carol Sinnott, Senior Clinical Research Associate and GP at THIS Institute, or Hugh Alderwick, Director of Policy at the Health Foundation.