Article Figures & Data
Figures
- Figure 1. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram of search
- Figure 2. Years of publication of sources (n=449)
- Figure 3. Description of sources (n = 449)
- Figure 4. Outcomes addressed by included sources. aSources could address multiple different outcomes. Other outcomes related to: self-management (n = 7), continuity (n = 6), costs (n = 6), medication-related (n = 4); implementation outcomes (n = 1); access for underserved or seldom heard groups (n = 2), other patient and staff impacts (n = 4), safety (n = 2), new guidance (n = 1).
Tables
- Table 1. Summary of the seven features of the Candidacy Framework for understanding access10
Feature Explanation Identification How people recognise their symptoms as needing medical attention or intervention is important to how they assert a claim to candidacy Navigation Using services requires knowledge of the available services and depends on having the practical resources to use them Permeability The ease with which people can use services depends on how many and what kinds of criteria people have to meet to use them, and on cultural and other alignments between services and individuals Appearances Appearing at services involves people making a claim to candidacy. It requires a set of competencies and socio-cultural alignments Adjudications Professional judgements about patients’ candidacy strongly influence individuals’ access to attention and interventions Offers and resistance Offers of care may be made that may be accepted (for example, utilisation) or refused (for example, non-utilisation) by individuals Operating conditions The perceived or actual availability and suitability of resources has a major impact on the local production of candidacy, as do other relevant operating conditions - Table 2. Summary of categorisation and the features of the Candidacy Framework addressed by each subcategory
Main categories Subcategories I N P Ap Ad Of OC Appointment innovations Triage 2 1 Telehealth 1 2 Restructuring appointment systems 1 2 Offering patient contacts that are not appointments 2 2 1 2 Direct patient access to services that remove need to access general practice Community pharmacists 1 2 Self-referral pathways 1 Increasing the number and range of professionals available to see patients within general practice Expansion and diversification of skill-mix 2 1 2 2 Improving GP recruitment and retention 2 Offering contacts beyond core hours, core settings, and core services Extended hours services provided by GPs within their own practice or practice network 1 GP services external to a patient’s practice or local practice network 1 Enhanced services within practices 2 1 Expanded or re-organised services within the wider community 2 2 1 2 Supporting patient engagement, empowerment, and education Educational initiatives targeting patients 1 2 2 2 Digital resources for patients 1 2 Practice-level interventions or interventions targeting practice staff and professional behaviour 2 2 2 1 2 2 System-level interventions targeted at patients 1 2 2 2 Supporting the internal and wider structures of general practice Making existing processes in practices more efficient 1 Reducing the burden of bureaucracy in general practices 1 Interventions to ensure general practices at high risk of closing stay open 1 Financial mechanisms for improving access 1 Contracting and commissioning to shape provider markets 1 Changes to the scale or model of general practice (not otherwise included) 1 Ad = adjudications. Ap = appearances. I = identification of candidacy. N = navigation. P = permeability. OC = operating conditions. Of = offers and resistance. See description of each feature in Table 1. ‘1’ indicates the candidacy feature most addressed by an intervention, ‘2’ indicates secondarily affected features.
Supplementary Data
- CS_10.3399BJGPO.2024.0184_supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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What’s been tried: a curated catalogue of efforts to improve access to general practice
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