Primary Care Pathfinder: discovery report – changes to access


5.8 Practices are changing how citizens access services

GP surgery staff spoke of a public perception (validated by research with citizens, among other sources) that GP surgeries were not seeing anyone face-to-face, when in fact they “never closed their doors”.

Practices described how the pandemic had changed how they handled appointments in the following ways:


During the pandemic:

Looking ahead:

‘Changes without explanation’

Experiences from citizens highlighted how, in their view, practices had introduced changes without attempts to explain or raise awareness about how new systems worked.

Some people were looking for reassurance that using new channels (a digital tool, for example) would not put them at a disadvantage to those using the phone. Where in doubt, they would try all or any channels they could.

Some people managed this well; others said the experience made them feel let down and, in some cases, angry that they were expected to absorb new ways of doing things that did not appear to have been designed with patients in mind.

Strained relations

The impact of these changes has strained doctor-patient relations. We heard both warm praise and real concern from citizens about the way practices were managing their services in 2022, with several interviewed blaming politics, austerity and social changes for the mismatch between demand and supply of GPs.

One said he was “pleasantly surprised and grateful” that anyone at the practice responded to his request early in the pandemic. Another was visibly upset by the process introduced over the same period at a practice in the same area of Wales:

‘I can’t speak to a doctor – how is this possible? It’s made as difficult as possible; you have a 15-minute window to try and get an appointment. Over the Christmas period [the practice] was shut for 4-5 days’


In interviews with practices we heard how, from their perspective, they are working extremely hard to manage during challenging times and with limited resources. Some practice staff hope patients will cooperate, sometimes voicing frustration that not everybody understands what is happening backstage.

Emotional and practical support

It is also clear from citizens and some GPs we spoke to that many doctors have consciously adapted their language and processes to provide emotional, therapeutic and practical support where they have noticed someone in need. Our research emphasised how important it is to use language and processes citizens understand and to provide emotional and therapeutic, as well as clinical, support.

We heard many times that some digital tools were not meeting various user needs, including those of basic efficiency and appropriate options for certain types of requests.

One online consultation tool proved particularly onerous, asking “the same question five times”. It also did not provide routes for standard tasks such as booking follow-up appointments, only allowing ‘yes/no’ options for answers at times where nuance would have been helpful.

5.9 Citizens’ preferences for accessing services depend on the context

There is compelling evidence in research of the need for choice over how services can be accessed by citizens. While the nature and severity of a person’s health condition is a clear factor when determining preferences for making and attending appointments, our user research heard how other aspects of patients’ lives (location, transport options, capabilities) also mattered significantly.

We heard how, on a case-by-case basis, an in-person appointment or remote conversation was strongly preferred by the same individual.

One citizen who worked long hours in a demanding job, described past irritation at long waits at the practice for face-to-face appointments in the past:

‘I’d be more than happy to have a phone call. You can talk to [the GP] over the phone, as long as they allow appropriate time to deal with your issue’


This person went on to describe how the process for phone appointments needed greater consideration, particularly when expected call-back times were missed by the GP, meaning the patient missed the phone call when it did come.

Ringing back, they were told they would have to rebook the appointment “as the doctor can only call once”. They felt this was an inflexible approach.

Others interviewed expressed similar experiences; one patient whose detailed understanding of a serious, chronic condition – and the implications of leaving it untreated during flare-ups – meant they pressed for an in-person appointment where treatment had to be administered in person.

Outside such relapses, the same person voiced a strong preference for telephone consultations with their secondary care specialist to avoid a tiring and painful journey:

‘I felt he [the specialist] was really listening
and not looking at his screen or the notes. I used to drive an hour, wait an hour (at least), have the appointment, wait another hour to have bloods done – then drive home another hour. Even if you can get a disabled parking bay, the [specialist] clinic’s the other side of the hospital. Now it’s a 30-minute appointment on the phone and you’re done. I don’t know why they haven’t done it years ago. You’re having the same conversation’


This person was not offered a video call but said they would have preferred that over other options for check-up appointments, “because the consultant’s actually looking at you”.

They felt the visual element to be important to communication and in helping the doctor to read their condition.

Others felt remote communication was not only acceptable but preferred in certain circumstances, including:

It became clear that there are opportunities to reduce the effort needed to travel to face-to-face appointments by using telephone and video consultations, provided that practices consider individual circumstances and preferences when offering these options to citizens.

‘I think if I was working it would be handy to have remote consultation as an option … I’d rather speak to someone in person – you get better engagement. And these days, time is not so much of an essence! Waiting is not a problem. For some people time is more important’


The overriding consideration in each case was the nature of the reason for contact, with “high stakes” situations (any potential bad news diagnosis) more likely to need an in-person appointment.

Our research findings support recommendations from Healthwatch England, Five principles for post-COVID digital healthcare (Healthwatch England, 2021):

  1. Maintain traditional models of care alongside remote methods and support people to choose the most appropriate appointment type to meet their needs.
  2. Invest in support programmes to give as many people as possible the skills to access remote care.
  3. Clarify patients’ rights regarding remote care, ensuring people with support or access needs are not disadvantaged when accessing care remotely.
  4. Enable practices to be proactive about inclusion by recording people’s support needs.
  5. Commit to digital inclusion by treating the internet as a universal right.

Some of the practices we spoke to recognised the need for a blended model in future, which gives citizens a choice of how they want to interact with GP surgeries.

Some also noted that new channels like online consultations have led to groups of citizens presenting that would not have done so previously:

‘Some people prefer conversations, but some people do prefer technology and not to talk. Some need the leading questions and soft touch when they are not so good at communication:
there’s a place for both’


Next: Different access models may lead to inequities