Hello and welcome to BJGP Interviews.

I'm Nada Khan and I'm one of the Associate Editors of the bjgp.

Thanks for listening to this podcast today.

In today's episode, we're speaking to Professor Helen Atherton.

Helen is professor of Primary Care Research based at the University of Southampton, and we've only just speaking to her recently on this podcast about the increasing digitalization of general practice.

This time we're speaking to her about her recent paper here in the BJDP titled what Do Patients Want from Access to UK General Practice?

So, hi, Helen.

It's really nice to speak again about this area of research and I guess I just wanted to start by saying that access is such a loaded word and really, when it comes to general practice, it's part of a fairly negative media campaign against general practice.

But it seems that this negative narrative just keeps getting pushed, despite lots of attempts to fix it.

So I just wonder if you could reflect on that.

Yeah, absolutely.

So that the negative media coverage was one of the reasons that I wanted to do this review.

So this review was a bit of a labour of love because I had a feeling from the work that I was doing on digital access and other research that actually the reality was probably quite different, what we were seeing in the headlines and having looked into it, although there's lots of research out there on patient experience and satisfaction, we have a national survey that looks at that.

There wasn't anything about what patients actually want.

And so that kind of.

I thought, actually, wouldn't it be really interesting to find out from the evidence what they actually want and see if it does fit with the narrative we see in the papers and on social media.

So, yes.

So completely agree.

And that was kind of where the idea came from, really.

Yeah.

And I just want to unpick what you really mean by access in this paper, because I think for some people it means, you know, just getting an appointment to see their GP within a day, but it can mean lots of different things to other people.

So what did you conceptualize that as?

Well, it was difficult.

And you're right, there are lots of different definitions of access, and particularly in the research context, for us, we were interested in access to an appointment, so we were very focused on the processes that patient would go through in order to get the appointment, go to the appointment.

And we did go back and forth several times with this review because it was so difficult to define and there will be other researchers who use different definition, but because we were so interested in a lot of the kind of media narrative.

It just felt like the best fit to look at access to an appointment with a gp.

So this paper was a systematic review and you looked at papers which explored different aspects of access.

And I guess the big question here is, what did patients want in terms of access?

I wonder if you could just give sort of a headline summary and then we can talk a bit more in depth about it.

Sure.

So what was interesting is I don't think their wants were particularly surprising or out of line with what general practice wants to deliver.

That's the first thing to say.

And it was things like wanting to choose a clinician that they've seen before, if they.

If they've seen a clinician before, wanting to have choice around the skill mix.

So which healthcare professional.

They saw the consultation modality wanting to have a good relationship with the practice.

They wanted ease of booking and relatively speedy access.

But not.

There wasn't any evidence that people all wanted to be seen on the same day, which is maybe how the media narrative goes.

And there were also some things around wanting it to be easy to get to and having a nice waiting room.

So really quite simple things as well.

I think choice is a really interesting area to explore.

So some people might not feel they have the right access if they get booked in, like you say with the gp, they don't know, or if they get booked in to see someone working in another clinical role in the practice.

But I wonder what you thought about the implications, given the increasing lack of continuity of care and this widening multidisciplinary team in practice.

Yeah.

So it didn't escape our notice that a lot of what we were seeing was probably at odds with current policy around general practice.

The fact that patients fully understand that continuity of care is important at times, and there's lots of evidence that that is the case.

And general practice, as a rule, tends to encourage that, I would say.

And then also with the skill mix at odds with the idea that you.

You can kind of sub in other healthcare professionals as a way to tackle lack of capacity.

Whereas I think patients are smarter than that and realise that sometimes it's appropriate, but other times it's not.

Yeah.

And then also with the digital as well.

So, again, people wanting the choice, understanding that sometimes it's better to do things that way or more convenient, but not wanting to be forced down that route, which is kind of the way that we're going, really, in terms of policy for digital access.

And.

Yeah, talk us through that.

What people thought about access in terms of the kind of consultation they got like a telephone or a face to face appointment.

Yeah.

So patients were happy to have those types of consultation.

So when it came to use of remote consultations, patients were happy to do that where it met a need.

So if they didn't want to come to the practice, they weren't able to.

Perhaps if they had a sensory disability, lots of reasons why they wanted to do it, but wanting to have the choice about how that happened, which was interesting.

So people would say they didn't want to have to travel to the practice because it wasn't convenient.

This could be around work or childcare, or it might be that they had mobility issues, but there was generally a reason why they didn't want to be in the proximity of the general practice.

And that's when remote consultations were what patients wanted.

Yeah, fair enough.

So it seems a lot of the time people just want a choice and I think it's interesting, particularly given the increase in a triage first approach in many practices.

But there was something you mentioned in the article that I thought was quite interesting, which was about co production with patients to solve access problems.

Just tell us what you think this should look like.

So as well as doing this review, I'm involved in other research around access to general practice.

And a big thing that we see happening is almost like a.

Not a lack of communication, but a miscommunication between patients and practices.

You know, not intentional, nobody's trying to confuse the other, but patients perhaps not really understanding the access systems in place, not understanding what is available to them.

If they don't have a choice, why they don't have a choice.

And so I think there's a lot of room for more kind of working together in terms of what that looks like.

I think we have to be brave and ask patients what they want.

This is a systematic review, so it looks at existing evidence and most of those studies were not focused on looking at just what patients wanted, they were looking at other things as well.

I think if we were to ask them what they wanted, we might get a bit more insight into how things can be tweaked or changed.

I think the problem is probably that that's quite a scary thing to say, what do you want?

Because what if patients say a load of things that, you know, can't happen?

But I think this review does quite a good job of showing that actually what patients want is quite simple and straightforward and those conversations together would perhaps generate some realistic solutions.

Better communication outwards to patients in a way that they understand.

That's really Interesting that you mentioned this mismatch because sometimes when I speak to patients, they say something to me like, oh, it's impossible to get through, impossible to get an appointment.

And I'm looking on our appointment screens and seeing lots of empty slots in this week and next week.

And I think our practice is doing really well.

But obviously there's a mismatch in how we're perceiving access, I suppose.

Yeah, that's.

I think that's right and I think that's something that's been shown in research that I've been involved in, but also others working in academic primary care and it's how we tackle that mismatch, I think that is really important.

Yeah.

So you touched on your other research around access.

What are the other things that you're looking at in terms of access to primary care?

So I have co led a study with Professor Catherine Pope at the University of Oxford, where we looked at long term sustainability of access approaches in general practice and that study finished quite recently.

So we're trying to disseminate some of those findings as well and seeing very similar results around this mismatch between the patient view and the practice view.

But also other interesting observations like the changes to the role of the receptionist.

So increasingly colleagues in academic primary care have been writing about this, but it's definitely the case that the introduction of digital services and triage and it's really the triage type approaches, has really changed the role of the receptionist.

But there's not necessarily been any space or time for general practice to reflect on that, to understand whether that role needs to be developed or even professionalised.

And it's perhaps something that we, you know, could consider looking at in more depth.

Other things arising have been around the sheer amount of work that general practice is doing to manage access.

So making tweaks and changes all the time to how access systems operate, which is almost a form of invisible work really, because it's not accounted for, but it's happening all the time.

And I think probably really important to acknowledge if we're thinking about how we set up long term sustainable approaches to access.

And if you could step into a practice where people felt dissatisfied with their access, what would you tell the practice team in terms how they could improve things or manage things better?

Well, I think I'd probably start by assuring them that it wasn't a criticism of necessarily of how they were doing things, because that is absolutely not the case and that is certainly not what our research demonstrates.

I would say that it's probably really important to open that dialogue and find out some more about what the specific issues are that patients are facing and perhaps have a look at where the kind of pinch points are in terms of patient dissatisfaction.

The other thing is it's very difficult.

I think when you're managing a huge amount of demand and having to kind of manage their capacity, it can be quite easy.

And again, this is something that we saw, we've seen in some of the research I've done in general practices, to really focus on this kind of amorphous demand and not necessarily remember to think that for a patient, their individual encounter is what matters to them.

There's probably some work to be done.

I'm not quite sure what it would look like around examining what a patient journey looks like in that particular practice.

So what happens to patients who call the practice and where do they end up?

It's difficult.

I don't know that I do have answers, but I think it's really great that we can shed some light on exactly what is happening and perhaps also shed some light on the fact that some of the policies that are meant to be helping probably are not helping when it comes to how patients experience and perceive general practice.

Yeah.

I don't know if you want to touch on that a bit more, because it does seem like the policy focus has been on faster access.

But some of the results from this work, and I think your previous work as well, suggests that actually quick access isn't necessarily the main goal for some patients when they want access to their general practice.

Yeah, absolutely.

And it's much, much more complex than that.

And you're absolutely right.

We've seen an announcement in the last few weeks about the expansion of the NHS app and how patients will be able to do more on the app.

But that completely ignores the fact that lots of people don't use the app.

Even when they do use can be quite sporadic.

It doesn't always match up with the systems that are in place in general practice for people to access care.

So it doesn't always link up very well with messaging.

There's an awful lot of work to be done.

But if you read the headlines, it would appear that this is going to save time and improve patient experience as well.

Yeah, it's going to be interesting to see what comes out of the upcoming long term plan, especially since the expansion of digital services and the NHS app seems to be such a critical part of that sort of three pronged approach to saving the nhs.

Really.

Yeah.

And there's also a wider question, I think around what we want general practice to look like.

So it seems that patients are saying they want it to keep looking like it's always looked, and be somewhere that they can see a clinician that they may know already in somewhere that is close to home and that they have a good relationship with, which is kind of at odds with some of the policies which, as you say, are pushing for fast access and high volumes of access, perhaps in a short space of time.

So what would you say that this paper really brings to the table in terms of those negative media, media portrayals that we started this conversation about?

Do you think it sort of reinforces them or does it suggest that actually those portrayals aren't completely capturing the patient experience?

Yeah, I would say that they're not completely capturing the patient experience.

And I think hopefully this review shows that what patients want isn't a million miles away from what general practice wants.

And that yes, there are always going to be some things that are a compromise, but it's, it's not necessarily a deal breaker for patients because there are so many factors that are important to them.

But I also hope that it shows that this is an area that we should be focusing more on.

So it would be really great, for example, if the general practice patient survey, as well as asking people about their experience, perhaps ask people about what they wanted.

I don't know how easy that would be to do, but it could be really useful in actually getting the perspective of the people who are using general practice on what they would like to see.

Yeah, really fascinating work, Helen.

And I know that you're doing a lot of work in this area, so, yeah, really look forward to seeing your other outputs in this area.

But it's been great to have a chat about this paper.

So I just wanted to say thanks again for joining me.

Thanks for having me, and thank you.

All very much for your time here and for listening to this BJGP podcast.

Helen's research article can be found on bjgp.org and the show notes and podcast audio can be found@bjgplife.com and just to say, this is the end of this season of the BJJP podcast and we're going to take a bit of an extended summer break.

We'll be back on the 9th of September with a new season of podcasts talking about recent research and clinical practice articles in the the bjjp.

So look forward to then.

But until then, thanks again.

And by.