Patterns in GP Appointment Systems: a cluster analysis of 3480 English practices.

Abstract

Background In response to increasing demand for appointments, UK general practices have adopted a range of appointment systems. These systems vary widely in implementation. These changes have not yet been clearly described. Aim Characterise patterns of primary care delivery in English general practices. Design and Setting Cross-sectional study using NHS Appointments in General Practice data from 3480 English GP practices, totalling 56 million appointments between August and October 2023. Method We derived 12 measures associated with consultation modality, waiting time, clinician type and triage use. Practices with similar characteristics of those 12 variables were clustered together using an ensemble machine learning approach. Clustering was validated using December 2023 data. The characteristics of each practice grouping were described using 2021 Census and NHS workforce data. Results Two main models of care emerged. 'Routine care' practices (n=2286) tended towards face-to-face appointments, often delivered by non-GPs with longer wait times. 'Same day care' (n=1194) practices, a third of practices, were more likely to use telephone consultations, deliver care with GPs, and provide same day appointments. Compared to 'Routine care' practices, 'Same day care' practices were more likely to be in urban areas, had younger populations (mean age 40 vs 41 years) and employed fewer patient-facing staff (2.0 vs 2.5 full time equivalents per 10,000 patients registered). Conclusion This study identified two dominant models of primary care delivery in England, reflecting differing approaches to managing patient access. These differences could have an impact on continuity of care and equity of access to primary care.