A paradox of problems in accessing general practice: a qualitative participatory case study

Area of Science:

• Health Services Research
• Primary Care Medicine
• Sociology of Health

Background:

• Longstanding issues with general practice access persist.
• Existing approaches often neglect user and provider perspectives.
• Established theories of access are underutilized in understanding complexity.

Purpose of the Study:

• To explore general practice access barriers from user and staff viewpoints.
• To apply an established theory of access to analyze complexities.
• To gain a multi-perspective understanding of primary care access.

Main Methods:

• Qualitative participatory case study in northwest England.
• Community-based participatory approach with interviews, focus groups, and observation.
• Inductive and abductive analysis informed by Levesque et al.'s theory of access.

Main Results:

• A paradox exists where demand for general practice both creates and conceals unmet needs.
• Reactive rules to manage demand have eroded care continuity.
• Complex rules and limited capacity hinder patient navigation, exacerbating health inequities.

Conclusions:

• Recognizing the access paradox offers new targets for intervention.
• Solutions can be developed to increase general practice capacity.
• Addressing unmet needs and improving access can reduce health inequities.