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Independents' Day

Patients cool on Advanced Access

By Steve Nowottny

Offering appointments within 48 hours does not improve patient satisfaction, a major new study has found.

The Advanced Access model has long been touted by the Government as the way for practices to reduce waiting times and ensure they hit the 48-hour access target. But the first large-scale multi-centre study looking at its implementation has concluded: 'We did not observe the dramatic benefits described in earlier uncontrolled reports and case studies.'

But the study also found no evidence to back up criticisms of Advanced Access, such as reduced continuity of care and increased workload for GPs.

Study leader Professor Chris Salisbury, professor of primary healthcare at the University of Bristol and a GP in the city, said: 'Patients in Advanced Access practices were more likely to be seen quickly, but less likely to book appointments in advance and no more or less satisfied.'

His team surveyed 11,000 patients from 24 Advanced Access practices and 24 control practices. 'Overall the most important factor was being able to choose to book an appointment on a day of their choice, rather than being able to book as soon as possible,' said Professor Salisbury, who presented the results at the sixth National Service Delivery and Organisation conference in London last week.

The Improvement Foundation, which promotes the formal Advanced Access model, said 'nearly every practice in England' now operated some form of advanced access.

'That's why it would be difficult for the study to have true controls and why the results between the groups were so similar,' said Sir John Oldham, head of the Improvement Foundation. 'Improvements in access have consistently been demonstrated in the large patient surveys by IPQ and others.'

Dr Sean Magennis, a GP in Wallasey in Cheshire, said he was generally 'very happy' with Advanced Access, but one of the drawbacks was that only a limited number of appointments were made available in advance.

'First thing in the morning our phones go absolutely crazy because we've got maybe 100 appointments to give out in the first half-hour,' he said. 'For people trying to get to work and ring the surgery and make an appointment for that day, it is still difficult.'

Key findings on Advanced Access

  • 'Although access to GP appointments was slightly faster in Advanced Access practices than control practices, we did not observe the dramatic benefits described in earlier uncontrolled reports and case studies.
  • ''Overall, patients were no more satisfied with appointment system in Advanced Access practices.'
  • 'Being seen quickly was less important to patients than being seen on the day of their choice.'
  • 83% of Advanced Access practices provided an appointment on the same day – higher than among control practices, but lower than the official 97% figure from official PCT survey data.

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