401. Has the NHS national extended access scheme delivered its policy aims? A case study of two large scale extended access providers.
- Author
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Burch P, Whittaker W, Bower P, and Checkland K
- Subjects
- Humans, England, Health Policy, Appointments and Schedules, Primary Health Care organization & administration, General Practice organization & administration, Male, Female, Organizational Case Studies, After-Hours Care organization & administration, Middle Aged, Interviews as Topic, State Medicine organization & administration, Health Services Accessibility organization & administration, Qualitative Research
- Abstract
Objectives: In 2018, NHS England mandated that all patients in England should be able to access general practice services outside of ordinary hours. While some patients would access additional hours at their own practice, others would need supra-practice level provision - that is, they would be seen in a different location and by a different care team. The policy aim was to enhance patient access to care, with a particular focus on those who work during the day. This study examines (a) how supra-practice level provision of extended access appointments for general medical problems are operationalised and (b) whether the aims of the policy are being met., Methods: This study presents qualitative comparative case studies of two contrasting service providers offering extended access. The data collected included 30 hours of clinician-patient observations, 25 interviews with staff, managers, and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data. Thematic analysis ran concurrently with data gathering and facilitated the iterative adaptation of data collection., Results: Three cross-cutting themes were identified: extended access is being used to bolster a struggling primary care system, extended access provides a different service to in-hours general practice, and it is difficult for extended access to provide seamless care., Conclusions: Supra-practice access models can provide effective care for most patients with straightforward issues. When ongoing management of complex problems is required, this model of patient care can be problematic., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The position of the lead researcher (PBu) as a GP may raise questions as to whether their role influenced the collection and interpretation of data. To address this, PBu used a reflexive diary throughout this study. PBu found that his view of extended access changed throughout the project and became more nuanced. Towards the end of the project PBu reflected that whilst extended access differs from ‘traditional’ general practice, it provides many extra appointments in a primary care system that is struggling to cope.
- Published
- 2024
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