Continuity of care and rapid access: the potential impact of appointment systems

Abstract

In recent years government emphasis on improving access times in general practice has centred on a target of 48-hour access to a doctor. Attempts to achieve this by changing appointment systems may threaten relationship continuity of care, another valued feature of general practice. Now the recent primary care White Paper proposes financial incentives for both these aspects of care. We studied two contrasting booking systems in three large inner London group practices using a one page questionnaire distributed to consecutive patients in the waiting rooms. While most patients in the so-called ‘advanced access’ practice were seen very quickly, fewer patients, especially those with chronic conditions, were able to see their chosen doctor than in two practices offering more scope for booking appointments ahead. This preliminary study in an inner-city area supports other work, as well as anecdotal reports, suggesting that unbalanced emphasis on rapid access may impair patients’ scope to see their practitioner of choice.