Access to general practice :a qualitative study of appointment making in general practice

MD ThesisThe aim of this thesis was to observe appointment negotiations in general practice, and investigate patients' and receptionists' experiences of appointment making. Improving access to health care is a National Health Service priority. These priorities are manifest when patients' request an appointment to see their GP. This study was conducted in three general practices on Tyneside: a singlehanded practice; a three doctor practice; and a seven-doctor practice. Two methods were used, participant observation, consisting of observing and recording practice activities and observations with informal interviews, and long interviews with patients and professionals. Activity recordings and observations were conducted in waiting rooms, behind reception counters, and in other settings. There were 35 activity recordings and 34 periods of observation. Thirty-eight patients and 15 professionals were interviewed. Participants were selected by theoretical sampling. These included 12 short interviews with patients attending an 'open access'surgery. Six groups of patients (23) and 15 professionals were selected for long interview. These included patients who complained about appointment making or who complimented the receptionists. Transcripts of observations and interviews were analysed by theoretical coding and data display to identify concepts and categories of data. Several methods were used to enhance the research's quality. Outcomes from appointment negotiations are influenced by patient's illness behaviour, the process of negotiation, and appointment availability. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Receptionists also work outside 'official' practice rules to manage limited appointment availability. These strategies include 'fitting patients in, ' reserving appointments, referring to other professionals and using advocates to support their actions. Patients volunteer information to provide evidence that their complaint is appropriate, and employ strategies, such as assertiveness, and threats, to try and obtain appointments. Receptionists have a crucial role in managing patient access that remains unacknowledged by policy makers.Sir Charles Hastings and Charles Oliver Hawthorne awards (BMA): Northern and Yorkshire RHA Research Practices Scheme