English general practice in a period of change: a mixed-methods study of staff and patient perspectives

The COVID-19 pandemic prompted widespread use of remote (telephone and online) communication in general practice in England, which exacerbated long-term pressures from staffing shortages. The public perceived problems with access.

To explore patient and staff perspectives on changing processes in general practice.

A mixed-methods study (patient survey and staff focus groups) in a sample of 22 general practices in England, varied by size, region, deprivation, and demography, was conducted in 2022.

An online survey was delivered by short message service (SMS) text to adult patients at 21 practices. Data from answers to an open-ended question about patients' experiences were analysed using summative content and thematic analysis. Virtual focus groups conducted with four categories of staff (GPs, nurses, receptionists and administrators, and practice managers) covered teamworking, roles, patient interactions, adapting to change, and workload. Data were transcribed and analysed using framework and thematic methods. Themes common to patients and staff were identified.

Overall median survey response was 10.9% (interquartile range 9.7%-14.6%); 14 401 patient responders provided 10 348 comments, 51.2% were positive. Patient and staff perspectives overlapped in two areas. The first, 'contact and communication', encapsulated differing views around access. The second, 'non-clinical roles and patient care', concerned the allocation of appointments and the roles of receptionists. Patients reported barriers to getting timely appointments with their chosen professional while staff were seeking ways to manage the volume of communications. Use of non-clinical staff to triage appointment requests was unpopular with patients and receptionists felt clinically unqualified.

Effective methods are needed to improve patient communication with practices and access. Receptionists require recognition and training for their pivotal role.