Knowledge has to be improved, challenged, and increased constantly, or it vanishes. Peter Drucker


Research & evidence - access and continuity in general practice

Primary Care leaders' key concern is the lack of capacity to manage growing demand, which in turn leads to a loss of continuity, central to the patient-doctor relationship.  Yet there is hope, through a GP innovation from which Patient Access was formed.  It is evidence based, with effects in practice shown in case studies.  Key findings from research on this page are secondary care demand reduction, and the transferability of the method into highly diverse practices.  
Our main work is to help new practices and CCGs adopt the innovation.  Papers and links are relevant to clinical and operational effects of access methods.  Original material is free to quote for non-commercial use with acknowledgement.


Primary paper on discovery of method

Comparison of mode of access to GP telephone consultation and effect on A&E usage  H Longman March 2012
Conference posters
Access & Continuity go hand in hand H Longman, S Coupe, poster at SAPC Society for Academic Primary Care, 3/10/2023
How a telephone call from a GP transforms patient access  H Longman, S Swift, K Singh, BMJ Int'l Forum, Paris, April 2012

Presentations and papers

NEW    Demand for GP related to deprivation  H Longman, analysis of unconstrained demand at PA practices, range from 5.5% to 10% of list per week

            Access & Continuity - the impact on secondary care  S Coupe, H Longman, presented at Commissioning Show 2012, 28/6/2012         

            Preliminary research on why A&E is rising and the variation by GP practice factors  H Longman, NHS copyright 2010

            Discovery of practices offering rapid GP phone call, linked to lower A&E attendance.  H Longman, presented 9/3/11, Healthcare Innovation Expo, NHS copyright     

            A&E reduction effect FY1011  Dr S Swift, EMQO, NHS copyright 2011, also looks at smaller emergency admissions effect      

            Survey of operational features and staff experience Also considers how fast a practice can change, and how patients react.

Links to external related research

                          Effect of GP continuity on elective demand: Leicester University study 2012, JPH, M Chauhan, Richard Baker et al.  

                          Cochrane Review on telephone consultation & triage 2009  Wide ranging review of a number of models.  None quite like Patient Access

                          Telephone Consultations BMJ 2003  Josip Car, Aziz Sheikh, positive review of the clinical evidence and issues

                          Evaluation of Advanced Access, Professor Chris Salisbury et al, 2007  Full scale review of a top down change programme.

                          NHS Information Centre study linking A&E, deprivation, GP survey  A circle linking deprivation, low satisfaction with GP and high A&E.

                          First publication of evidence linking telephone access and A&E effect  through EMQO site for NHS East Midlands.

                          Review of NHS Direct research  No evidence found of effect on A&E.  54% of referrals made to GP, 20% to A&E in study of 258 calls.


"The end of surprise would be the end of science.  To this extent, the scientist must constantly seek and hope for surprises."

                                                                                                                                                                                                                                                Robert Friedel