What's been tried: a curated catalogue of efforts to improve access to general practice

Background: Although increasing numbers of appointments are being provided, public satisfaction with access to UK general practice is declining. Previous attempts to improve access have not been systematically collated.

Aim: We aimed to identify interventions to improve access to general practice in the UK, to organise these interventions into thematic categories, and to identify which aspects of access are targeted.

Design & setting: Narrative systematic review.

Method: A three-stage search was conducted to identify interventions used to improve access to NHS general practice. Using an iterative process, we generated thematic categories to classify interventions according to how they are intended to work. We assessed which aspects of access they addressed using the seven-feature Candidacy Framework.

Results: The search identified 449 relevant sources reporting on interventions to improve access to general practice over the period 1984-2023. We generated six overarching thematic categories into which we organised these interventions: appointment innovations; direct patient access to services; increasing the number and range of professionals available in general practice; offering contacts beyond core hours, core settings and core services; supporting patient engagement; and supporting the wider structures of general practice. We assessed which features of Candidacy were addressed, with "permeability" (the ease with which people can use) services emerging as the most frequent feature.

Conclusion: Multiple and diverse attempts have been made to improve access in general practice over a 40-year period. This curated, thematised catalogue offers an important resource for future efforts to improve access.