Research into practice: accessing primary care.

Abstract

In global health care,1 and within the UK NHS,2 providing accessible primary care remains a top-level priority for patients, politicians, healthcare planners, and health professionals. At its most basic, ‘access’ is simply the ability of an individual or population to obtain health care. Historical research3 has identified that strong primary care within national healthcare systems is associated with improved health outcomes, lower health system costs, and better patient experience of care compared with settings where primary care is more weakly represented. However, the simple provision of primary care is insufficient to ensure such beneficial outcomes — primary care services need to be made accessible to the population. For example, Kringos and colleagues4 have recently shown that, across Europe, financial investment in health care at national level, and even financial investment in primary care, are in themselves not sufficient mechanisms to drive high-quality access to primary health care. Although a superficially obvious concept, several models of access to health care have been proposed.5–7 Access might usefully be seen as the smoothness of fit between demand for services and the organisation of those services. In the UK, in 1995 a consultation rate of 3.9 per person per year was associated with an annual UK primary care consultation volume of 225 million consultations, by 2009 those figures had risen to 5.5 and 304 million respectively.8,9 This may in part be caused by supplier-induced demand related to more proactive health promotion and chronic disease management, and also by doctors themselves, with inequalities between patients and doctors in knowledge and power resulting in increasing patient demand for services.10 Changes in the provision of care will have an impact on demand and workload. In the UK, the structure and organisation of primary care has changed …