Understanding the human fit of access during initial recovery from the COVID-19 pandemic: a qualitative study in English general practice.

Abstract

Access to general practice in England is a challenging issue of enduring importance. COVID-19 precipitated various abrupt changes, exposing and compounding existing problems. The access as human fit conceptualisation provides a nuanced understanding of access that extends beyond a limited focus on appointment numbers and speed. This qualitative study explored the pandemic's impact on access to general practice and the experiences of patients and healthcare staff in England using access as human fit as an analytical framework. A community-based participatory approach underpinned by qualitative semi-structured interviews and focus groups, and observations. The following were conducted in Northwest England (December 2021-August 2022): interviews (10 participants) with patients, general practice staff and professionals; seven focus groups (42 participants) with patients from general practice patient groups and underserved groups; and twenty observation sessions of non-clinical access encounters (seven general practice and Primary Care Network premises; 45 hours total). A rapid qualitative analysis methodology facilitated an abductive thematic approach, applying the dimensions of access as human fit to the data. The access as human fit framework highlighted key areas where there is a lack of fit between patients and staff. Patients expressed that the array of access options and changes made it hard to know how to be a patient; some thought general practice should be 'back to normal' and the pandemic was an excuse to restrict access. Providers reported working harder than ever with insufficient resources. The pandemic created greater distance between staff and patient realities of access. Access as a human fit facilitated in-depth exploration of patient and staff experiences, improving understanding and identifying key issues. Broader adoption and application of this framework, within policy and practice, could focus improvement efforts, optimise access fit and improve patient satisfaction and staff retention.