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Access to primary care: advanced... or smart?

Access is back. Recent pronouncements by the prime minister and several UK health ministers have once again moved access to UK primary care services' centre stage, replacing choice, voice, and practice-based commissioning of services. The spectre of extended opening hours for GP services accompanies the politicians' commentary on access targets, and on the contribution of walk-in centres, NHS Direct, A&E departments, and primary care out-of-hours services to the increasingly complex patchwork of front-line NHS provision.

But this explosion in provision, accompanied by substantial investment in NHS service delivery, has not resulted in the end-user benefits that were anticipated. Significant sections of the population feel disenfranchised from primary care, as reported by the Secretary of State for Health who has warned that the results of the forthcoming GP–Patient Survey of 5 million NHS patients, and costing £11 million, may make ‘uncomfortable reading for some doctors’ on account of reported difficulties ‘for a significant minority of patients’ in accessing GP services.1

In these public statements, the spectre of political expediency and the courting of political popularity loom large. The recently announced review of NHS care led by Professor Ara Darzi has, as a central focus, the delivery of ‘more accessible and more convenient care integrated across primary and secondary providers, reflecting best value for money and offering services in the most appropriate settings for patients’.2 But such aspirations are not new. Building on proposals outlined in the NHS Plan,3 Department of Health initiatives in 2002 encouraged practices to meet recently defined targets for the accessibility of GP care included the wholesale roll-out of ‘Advanced Access’.4 This approach to managing appointment systems was developed in the …