{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T17:02:02Z","timestamp":1788109322840,"version":"build-2803163510"},"reference-count":40,"publisher":"Royal College of General Practitioners","issue":"764","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"accepted":{"date-parts":[[2025,8,6]]},"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Access to an appointment with a GP is important to patients, but hard to achieve in modern general practice, with general practice delivering more consultations than ever before. Research has focused on discrete systems for managing access in general practice, for example, telephone prioritisation, and these have been demonstrated to be variably successful in managing demand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To examine the sustainability of previous attempts to improve access to GP appointments to understand if access systems previously deployed have been adapted, abandoned, or sustained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>This was a focused ethnographic comparative case study in eight English general practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Qualitative observation, semi-structured interviews, and documentary analysis were undertaken. The study included 74 patient and 70 staff interviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Approaches to managing access are heavily focused on management of demand, and general practices constantly change access systems to try to achieve this. In all the case-study practices, access solutions previously deployed were adapted, rather than abandoned or adopted, usually via ongoing changes or \u2018persistent tinkering\u2019. The complexity introduced by these adaptations can be confusing for patients and fuels dissatisfaction, stress, and hostility. Persistent change to access systems creates unintended consequences and significant work for all involved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Persistent tinkering is a necessary and reasonable response to the challenges of access in general practice. In part this is because the problem is framed as one of managing demand. An alternative approach might investigate what patients want or need and consider how best this could be delivered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3399\/bjgp.2025.0140","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T14:35:15Z","timestamp":1756823715000},"page":"e204-e212","source":"Crossref","is-referenced-by-count":3,"title":["Access to general practice appointments and sustainable change: a focused ethnographic case study"],"prefix":"10.3399","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7072-1925","authenticated-orcid":false,"given":"Helen","family":"Atherton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9792-8299","authenticated-orcid":false,"given":"Abi","family":"Eccles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1484-9032","authenticated-orcid":false,"given":"Carol","family":"Bryce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5627-1684","authenticated-orcid":false,"given":"Annelieke","family":"Driessen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8237-322X","authenticated-orcid":false,"given":"Toto","family":"Gronlund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Pope","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"2026031009301570000_76.764.e204.1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp19X700757"},{"key":"2026031009301570000_76.764.e204.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.q1622"},{"key":"2026031009301570000_76.764.e204.3","unstructured":"Fisher R Beech J Alderwick H (2024) Rethinking access to general practice: it\u2019s not all about supply (The Health Foundation), accessed. https:\/\/www.health.org.uk\/publications\/long-reads\/rethinking-access-to-general-practice-it-s-not-all-about-supply. 10 Dec 2025."},{"key":"2026031009301570000_76.764.e204.4","unstructured":"NHS England (2024) Delivery plan for recovering access to primary care: update and actions for 2024\/25 (NHS England), accessed. https:\/\/www.england.nhs.uk\/long-read\/delivery-plan-for-recovering-access-to-primary-care-update-and-actions-for-2024-25\/. 10 Dec 2025."},{"key":"2026031009301570000_76.764.e204.5","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2023.0149"},{"key":"2026031009301570000_76.764.e204.6","doi-asserted-by":"publisher","DOI":"10.3399\/BJGPO.2024.0184"},{"key":"2026031009301570000_76.764.e204.7","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-11-288"},{"key":"2026031009301570000_76.764.e204.8","doi-asserted-by":"publisher","DOI":"10.2196\/44944"},{"key":"2026031009301570000_76.764.e204.9","unstructured":"Darzi A (2024) Independent investigation of the National Health Service in England (Department of Health and Social Care), accessed. https:\/\/assets.publishing.service.gov.uk\/media\/66f42ae630536cb92748271f\/Lord-Darzi-Independent-Investigation-of-the-National-Health-Service-in-England-Updated-25-September.pdf. 10 Dec 2025."},{"key":"2026031009301570000_76.764.e204.10","doi-asserted-by":"publisher","DOI":"10.1258\/135581906777641721"},{"key":"2026031009301570000_76.764.e204.11","doi-asserted-by":"crossref","unstructured":"Beech J Fraser C Gardner T (2023) Stressed and overworked: what the Commonwealth Fund\u2019s 2022 International Health Policy Survey of primary care physicians in 10 countries means for the UK (The Health Foundation), accessed. https:\/\/www.health.org.uk\/reports-and-analysis\/reports\/stressed-and-overworked. 10 Dec 2025.","DOI":"10.37829\/HF-2023-P12"},{"issue":"12","key":"2026031009301570000_76.764.e204.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0227280","article-title":"General practitioners\u2019 consultation counts and associated factors in Swiss primary care \u2014 a retrospective observational study","volume":"14","author":"Rachamin","year":"2020","journal-title":"PLoS One"},{"key":"2026031009301570000_76.764.e204.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61058-8"},{"key":"2026031009301570000_76.764.e204.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4197"},{"key":"2026031009301570000_76.764.e204.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-058247"},{"key":"2026031009301570000_76.764.e204.16","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp19X702197"},{"key":"2026031009301570000_76.764.e204.17","doi-asserted-by":"publisher","DOI":"10.1002\/msc.1599"},{"key":"2026031009301570000_76.764.e204.18","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp19X706157"},{"key":"2026031009301570000_76.764.e204.19","doi-asserted-by":"publisher","DOI":"10.3399\/BJGPO.2023.0208"},{"key":"2026031009301570000_76.764.e204.20","doi-asserted-by":"publisher","DOI":"10.3399\/BJGPO.2020.0179"},{"key":"2026031009301570000_76.764.e204.21","unstructured":"Salisbury C Banks J George S (2011) An evaluation of advanced access in general practice. accessed. https:\/\/eprints.soton.ac.uk\/67203\/. 10 Dec 2025."},{"key":"2026031009301570000_76.764.e204.22","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2021.0426"},{"key":"2026031009301570000_76.764.e204.23","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019966"},{"key":"2026031009301570000_76.764.e204.24","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-025-02683-z"},{"key":"2026031009301570000_76.764.e204.25","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"2026031009301570000_76.764.e204.26","unstructured":"National Institute for Health and Care Research (NIHR) (2024) Whatever happened to all those attempts to change access to general practice? Revisiting case studies to learn about innovation, impact and SUStainable change (GP SUS) (NIHR), accessed. https:\/\/fundingawards.nihr.ac.uk\/award\/NIHR133620. 10 Dec 2025."},{"issue":"9","key":"2026031009301570000_76.764.e204.27","first-page":"1","article-title":"Guidance on performing focused ethnographies with an emphasis on healthcare research","volume":"18","author":"Higginbottom","year":"2013","journal-title":"Qual Rep"},{"key":"2026031009301570000_76.764.e204.28","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2024.0137"},{"key":"2026031009301570000_76.764.e204.29","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp18X694853"},{"key":"2026031009301570000_76.764.e204.30","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2023.0216"},{"key":"2026031009301570000_76.764.e204.31","unstructured":"Miles M Huberman M Salda\u00f1a J (2014) Qualitative data analysis: a methods sourcebook (Sage Publications, London)."},{"key":"2026031009301570000_76.764.e204.32","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2929.2006.02467.x"},{"key":"2026031009301570000_76.764.e204.33","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-8-63"},{"key":"2026031009301570000_76.764.e204.34","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8775"},{"key":"2026031009301570000_76.764.e204.35","doi-asserted-by":"publisher","DOI":"10.1186\/1475-9276-12-18"},{"key":"2026031009301570000_76.764.e204.36","doi-asserted-by":"publisher","DOI":"10.1017\/S1744133121000293"},{"key":"2026031009301570000_76.764.e204.37","doi-asserted-by":"publisher","DOI":"10.14361\/transcript.9783839414477"},{"key":"2026031009301570000_76.764.e204.38","unstructured":"Royal College of Obstetricians and Gynaecologists (2024) Work as imagined versus work as done (RCOG), accessed. https:\/\/www.rcog.org.uk\/about-us\/quality-improvement-clinical-audit-and-research-projects\/each-baby-counts-learn-support\/safety-thinking-toolkit\/work-as-imagined-versus-work-as-done\/#:~:text=Work%2Das%2Ddone%20is%20the,%2C%20procedures%2C%20standards%20and%20guidelines. 10 Dec 2025."},{"key":"2026031009301570000_76.764.e204.39","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2021.0720"},{"key":"2026031009301570000_76.764.e204.40","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2021.0375"}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/BJGP.2025.0140","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T20:30:50Z","timestamp":1773261050000},"score":1,"resource":{"primary":{"URL":"http:\/\/bjgp.org\/lookup\/doi\/10.3399\/BJGP.2025.0140"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,2]]},"references-count":40,"journal-issue":{"issue":"764","published-online":{"date-parts":[[2026,2,26]]},"published-print":{"date-parts":[[2026,3,1]]}},"alternative-id":["10.3399\/BJGP.2025.0140"],"URL":"https:\/\/doi.org\/10.3399\/bjgp.2025.0140","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,2]]}}}