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Family Practice Advance Access published online on December 19, 2005
Family Practice, doi:10.1093/fampra/cmi104
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© The Author (2005). Published by Oxford University Press. All rights reserved.
Received October 27, 2004
Accepted November 4, 2005

Article

Advanced access: more than just GP waiting times?

Simon Dixon 1 *, Fiona C. Sampson 1, Alicia O'Cathain 1, and Mark Pickin 1

1 School of Health and Related Research, University of Sheffield, Sheffield, UK

* To whom correspondence should be addressed.
Simon Dixon, E-mail: s.dixon{at}shef.ac.uk


  Abstract

Background. Advanced access has been forwarded as a strategy for reducing waiting times in primary care; however, previous evaluations have raised important issues regarding its appropriateness.

Objectives. The objectives of this paper are to assess the impact of advanced access on patient access to primary care services, and its broader effects on stakeholders.

Methods. A quantitative analysis of appointment data on 462 practices implementing advanced access, together with qualitative analysis of open survey responses and interviews with 28 practice staff. Appointment data recorded time to third available appointment for GP and practice nurse, together with the percentage of patients seen on their day of choice. Themes were identified from the interviews and survey responses and related to issues identified in previous research.

Results. The implementation of advanced access was associated with reductions in time to see practice nurses as well as GPs, and increases in the proportion of patients being seen on their day of choice. Interviewee and survey responses suggested that practice population characteristics may impact on the model, and some patient groups may be disadvantaged from the changes in the appointment systems seen in this study. Whilst experiences were mixed, the potential for broader changes to working practices of all practice staff was evident.

Conclusions. In general, these results suggest that advanced access can have a positive impact across several aspects of primary care services, and not just the availability of GP appointments. However, it also highlights some problems, in that waiting times worsened in some practices and there were concerns that some vulnerable groups may be disadvantaged.

Keywords: Continuity of patient care; family practice; health services accessibility; models; organizational.
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