Patterns in GP appointment systems: a cluster analysis of 3480 English practices.

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: To 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: Twelve measures associated with consultation modality, waiting time, clinician type, and triage use were derived. Practices with similar characteristics for 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 with 'routine care' practices, 'same-day care' practices were more likely to be in urban areas, had younger populations (mean age 40 years versus 41 years) and employed fewer patient-facing staff in extended roles (all clinical staff except doctors and nurses) (2.0 versus 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.