Whatever happened to all those attempts to change access to General Practice? Revisiting case studies to learn about innovation, impact and SUStainable change. (GP SUS)

Background: There is a crisis in General Practice that pre-dates the pandemic. Access to appointments has been described by our PPI advisors as the single most important issue for patients. Several innovative systems and approaches intended to improve access have been studied in England but results have been inconclusive and contradictory. Post pandemic General Practice will need to reconfigure access. We see untapped potential to learn from what happened in practices that participated in earlier evaluations of different access systems and which subsequently continued, adapted or abandoned the approach. The experiences of these practices and the patients they serve could provide rich insights into the sustainability of access models, in different GP contexts, before and during the pandemic. Aim: To work with General Practices that have in the past tried interventions designed to improve access for patients, to learn whether and how these innovations were abandoned, adapted or sustained, and to use this learning to support long term improvements in access to general practice. Objectives: 1. To create a typology of different organisational approaches and digital technologies used to enable patient access to general practice appointments (with a GP or other primary care clinician, via to face to face, phone or online consultations). 2. To describe and compare the longer-term impacts of different approaches to patient access to General Practice (including the rapid changes introduced during the 2020-21 Covid-19 pandemic) to understand whether the various approaches worked as anticipated, were adapted or abandoned, and whether practices were able to sustain any improvements over time. 3. To distil and develop deep, transferable learning about sustainable approaches that support and improve access to General Practice. Methods: Three work packages include a scoping review, case studies and an integration and implementation phase. We propose focused ethnographic case studies in 8 English practices that were part of a variety of access intervention studies that completed at least 18 months before March 2020. As a comparator our Danish collaborators will use the same methods for a case study of the NF33 practice in Copenhagen which has several years’ experience of successfully implementing a same day appointments model which has reduced demand while increasing responsiveness. Drawing on key contemporary theories about implementation, adaptation and abandonment our focused ethnographies (8 English sites, 1 Danish) will include observations in practices, interviews with a purposive sample patients (up to 15 in each practice) and with staff of all types (6- 8 in each practice). Analysis will use thematic approaches and cross case comparisons with a particular focus on what supports long lasting improvements that work for everyone. Anticipated impact and dissemination: By drawing on experiences at least three years after the practice participated in evaluation studies of access interventions we will maximise learning about real world implementation using timely and cost effective focused ethnographic case studies. We will feedback to participating practices and prepare policy briefing papers during the study, with steering group contributions from policy and professional stakeholders, and embedded PPI throughout. Three workshops will create resources to support future and sustained change.