Title: Optimising people-centred access in primary care in the context of Covid-19: facilitating organisational and policy change
Funder: Department of Health and Social Care

Abstract: BACKGROUND General practice access is an important policy issue, but previous attempts to improve access have tended to use a very narrow definition of access, and have not taken account of research literature or theoretical understandings of what good access means. Covid-19 has driven drastic changes to GP access, including a rapid shift to telephone/online consultations. It is unclear whether these changes have improved or hampered access, for which patient groups, and which should be retained or abandoned. We will build upon recent research which provides a more nuanced, comprehensive framework within which to think about what better access might look like: people-centred access. This approach focuses upon the fit between peoples diverse needs and abilities and the needs and abilities of the organisations providing care. We will consider how policy can support this, and develop and disseminate resources to help GP practices reflect on improving access, focusing upon approaches to mitigating inequalities. OBJECTIVES AND RESEARCH QUESTIONS 1. Understand national change and access policy priorities a) How have patterns of access to primary care changed in response to Covid-19 nationally? b) How do primary care policy makers understand access, and what are their priorities? 2. Collaboratively work with GP practice sites to develop an optimising access resource set (OARS) a) How are practices thinking about access in the post-first wave Covid-19 environment? b) How can practices and patients be supported to conceptualise people-centred access and develop plans about how to optimise equitable access as the NHS recovers? c) What would an effective optimising access resource set contain? 3. Inform national policy development a) What policy approaches would support GP practices to improve access and reduce inequalities? METHODS AND DISSEMINATION We are working with a Community-based Participatory Research Team (CBRT; comprising patients, GPs, and local stakeholders) in Tameside and Glossop (T&G) who have contributed to the vision and design of this research, and will be involved in research activities. WP1: Quantitative analysis of national 2020 GP appointment data exploring patterns of Covid-19 related change. Qualitative interviews with GPs and relevant stakeholders in T&G, and three other areas of England, to understand how and why changes were made. Interviews with policy makers (DHSC and NHSE/I) about current access policy to explore their aspirations and information needs. WP2: We will recruit 3 GP sites in T&G, and then 1 each in 3 other areas nationally. Informed by realist principles we will work with each site for several months, conducting interviews, observations and focus groups with professionals and patients to support them to diagnose issues with current access arrangements and identify changes. Through this process we will develop and refine the content of the OARS and consider what policy changes would be helpful. WP3: We will present policy makers with our analysis of appointment data in Spring 2020. We will work with RCGP to finalise and disseminate the OARS to practitioners, and present our findings to policy makers and stakeholders making suggestions for how OARS could be supported by national policy (e.g. QOF).

Lay abstract: Why this research is important Making sure people can get care from their GP practice when needed is a key government priority. This is often known as improving access to care. Certain groups in the population find it harder than others to get care they need. Covid-19 (Coronavirus) has meant GP practices have reorganised how they provide care very quickly, for example offering more telephone and fewer face-to-face appointments, and they will need to continue to adapt as the Covid-19 threat changes. These changes have been good for some, but not others. In previous research we developed a new, broader way of thinking about what improving access to general practice means that considers different people s needs and wants. This has sometimes been lacking in attempts to improve access. Now is a good time to try to tackle access problems, because practices need to make decisions about what to do next. Policy makers are also focusing on access, and they need good evidence to help them decide how to design the rules and payment systems which govern what practices do. Our plan The research has 3 parts: 1. We will look at data from GP practices across England to see what kinds of appointments they have provided in 2020, and describe changes that have occurred due to Covid-19. We will interview national policy makers to understand how they think about access and what their priorities are. We will also interview representatives from GP practices about changes they have made. 2. We will work with 3 GP practices and other organisations in Tameside & Glossop (T&G), Greater Manchester, and 3 GP practices elsewhere in England. In T&G we have established a community group including doctors, patients, practice staff, and people from other local organisations to help us throughout. We will interview doctors and others from T&G practices, patients, and other local stakeholders to understand challenges and approaches to GP access from different perspectives. We will work with our community group to develop a set of resources for GP practices to use to optimise access. We will develop the set of resources with the 3 other GP practices and make improvements so it is useful for GP practices everywhere. We will also consider how national rules, payments and policies which govern what practices do might be changed. 3. We will provide early findings to policy makers in Spring 2021. We will work with the Royal College of GPs to finalise our access resources and provide these to GP practices across the country. We will present our final findings and access resources to national policy makers. By influencing policy and practices, access experiences for all groups of patients can be improved and inequalities reduced.

Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE