Access to general practice

Nada Khan is an Exeter-based GP and an NIHR Academic Clinical Lecturer in General Practice at the University of Exeter. She is also an Associate Editor at the BJGP.

‘I can never get an appointment with my GP’ – it’s a common sentiment amongst the UK public, that sense of not being able to get through, or see a doctor when they feel they need to. The Health Foundation has recently identified that the public’s first big priority across the NHS is to make it easier to get an appointment at their GP practice.¹  This has been spun as an issue around access, but what does access really mean in general practice, and is it all just about getting an appointment as quickly as possible?

Access isn’t just about the number of appointments

Policy directives to increase access to general practice have primarily focussed on increasing the number of appointments available to patients. Back in 2023, NHS England published their ‘Delivery plan for recovering access to primary care’.  This access plan, and subsequent updates, focussed on improving GP phone systems, offering more appointments by increasing the multidisciplinary team, expanding community pharmacy services and cutting back on ‘bureaucracy’ like QOF to give GPs back their time.² For some indicators this access plan has been viewed as a success. Practices in England are delivering record numbers of appointments, with a good proportion of these offered on the same day.  The general practice workforce has undergone an expansion with a massive shift towards increased multi-disciplinary working.  What this access plan hasn’t necessarily addressed are the deeper issues like the shortage of GPs, practice funding constraints in the face of inflationary pressures, and the ever-increasing demand for services amongst an aging population.³ Access issues need tackling at its deeper roots for long-term general practice sustainability and patient satisfaction.

Aside from just increasing the sheer number of available slots, there are several strategies practices can employ to try to improve and increase access. Practices can change the way patients access appointments through booking systems, employing strategies like total triage for all incoming requests or booking a patient in with a member of the multidisciplinary team instead of a GP. Or, practices can change the way appointment capacity is organised, by changing how far in advance appointments can be booked, limiting the number of same-day appointments, or offering extended hours clinics.⁴  Changing appointment systems can have repercussions.  Complex access and triage systems are not equitably accessed by all patients, and providing more quick access, same day appointments means fewer routine appointments which can exacerbate waiting times.  All of these tweaks can impact access, and importantly, the patient experience.

Online access – does this count?

Access to online services is increasing in general practice in the context of a ‘digital first’ approach to the NHS. Does better online access mean happier patients?  Not quite – the GP Patient Survey shows that public satisfaction with access to general practice has been plummeting despite the increasing availability of online services.⁵

We should tread carefully when thinking about access and digital services. Helen Atherton and colleagues warn against conflating access with online services in their recent ethnographic research looking at digital service use in general practice.⁶ What patients really valued was access to a health professional, usually as quickly as possible, in any way possible, and online services were seen as one way to get that access. The problem with some services was that useability was often not tailored around the needs of patients and carers, and didn’t always achieve the intended efficiencies to practices and GPs. In an article BJGP’s editor Euan Lawson described as encapsulating the ‘enshittification’ of general practice, researchers found that digital access can reduce efficiency, and was achieved at the ‘expense of digital exclusion’ for others.⁷  Digital-first approaches can also increase general practice workload, and impacts adversely on available resources, leading to a negative spiral of leading to worsening access due to decreased resource.⁸ This all sounds dangerously like it’s compounding, not solving the problems of access to general practice.

The patient perspective

The crux of this is the patient experience of access to general practice, which has deteriorated despite the increasing number of appointments, increasing digital access and the high proportion of same day appointments offering quick access to care. The patient experience of access isn’t just about how quickly someone can get an appointment. There are other factors at play, for instance, how easy it is to make that appointment and with whom in the clinical team, how long the wait is for an appointment and the modality of appointment offered. Patients might be happy to wait for a specific clinician to maintain relational continuity for non-urgent issues, but might want to see anyone quickly for urgent issues.⁹

The increasing use of the multi-disciplinary team has increased appointment numbers, and some patients are happy to see professionals such as a pharmacist in the practice.  However, patients often prefer to see a GP, and may equate access with seeing their GP and not a member of the multi-disciplinary team or their community pharmacist. Some patients will prefer to see a GP, for instance, if they feel they have a condition that is worsening, or after an initial assessment with a non-GP member of the team.⁹ The main priority for patients is choice, and this was facilitated by having a positive relationship with the practice with simple booking systems and good communication from the practice on how to access services.⁹

Finally, the policy focus on quick access has come at the expense of continuity of care. Jennifer Voorhees asks us to think more about unmet need rather than access, alongside restoring continuity and being flexible towards appointment access, an approach they describe as ‘human fit’ to access.¹⁰ All of the rules we are putting in place in general practice to manage demand are reducing continuity, and leading to increased work, creating a paradox of access to care. Better understanding the relationships between access issues can help to free up capacity and provide more equitable care to people with higher need.¹⁰

What next?

A team from the Health Foundation and The Healthcare Improvement Studies Institute used the candidacy framework, a way of looking at access through ‘multiple diverse and interdependent influences’.¹¹  They also provide a helpful summary of over 400 attempts to improve access in general practice, well worth a read to see what’s worked and what hasn’t over the past 40 years. It’s interesting to note that many innovations int this summary, like telehealth and asynchronous communication can increase demand, as clinicians eventually, after a number of contacts, just need to get the patient in for a face to face review, which isn’t a great experience for patients or the clinical team.

What’s clear from all this work is that access does not mean just offering more appointments. And tackling access means dealing with the other factors contributing to access like how to incorporate the increasing digitalisation of appointment systems, workforce retention and more equitable practice funding. Access is going to be challenging in any system where demand outstrips resources, but thinking carefully about the aspects of access that matter to patients can help practices understand how to fit their services to meet patient need.

References

1. Benniche SC, G.; Gardner, T.; Alderwick, H. Public perceptions of health and care under the new government: The Health Foundation; 2025 [Available from: https://www.health.org.uk/reports-and-analysis/analysis/things-can-only-get-better.
2. Delivery plan for recovering access to primary care. London: NHS England; 2023.
3. Fisher RB, J.; Alderwick, H.; Price, E.; Ansari, A.; Dixon-Woods, M.; Sinnott, C. Rethinking access to general practice: it’s not all about supply: The Health Foundation; 2024 [Available from: https://www.health.org.uk/publications/long-reads/rethinking-access-to-general-practice-it-s-not-all-about-supply.
4. Eccles A, Bryce C, Driessen A, Pope C, MacLellan J, Gronlund T, et al. Access systems in general practice: a systematic scoping review. Br J Gen Pract. 2024;74(747):e674-e82.
5. NHS. GP Patient Survey 2025 [Available from: https://www.gp-patient.co.uk/.
6. Newbould J, Bryce C, Stockwell S, Treadgold B, Campbell J, Marriott C, et al. Supporting patients to use online services in general practice: focused ethnographic case study. Br J Gen Pract. 2025.
7. Payne R, Dakin F, MacIver E, Swann N, Pring T, Clarke A, et al. Challenges to quality in contemporary, hybrid general practice a multi-site longitudinal case study. Br J Gen Pract. 2025;75(750):e1-e11.
8. Salisbury C, Murphy M, Duncan P. The Impact of Digital-First Consultations on Workload in General Practice: Modeling Study. J Med Internet Res. 2020;22(6):e18203.
9. Atherton H, Leach H, Mortell R, Parsons J. What do patients want from access to UK general practice? Br J Gen Pract. 2025.
10. Voorhees JB, S.; Waterman, H.; Checkland, K. A paradox of access problems in general practice: a qualitative participatory study. British Journal of General Practice. 2024.
11. Sinnott C, Ansari A, Price E, Fisher R, Beech J, Alderwick H, et al. Understanding access to general practice through the lens of candidacy: a critical review of the literature. Br J Gen Pract. 2024;74(747):e683-e94.

Featured photo by Tim Mossholder on Unsplash.