English general practice in a period of change: A mixed methods study of staff and patient perspectives.

Background: The covid-19 pandemic prompted widespread use of remote (telephone and online) communication in general practice in England which exacerbated long-term pressures from staffing shortages. The public perceived problems with access.

Aim: To explore patient and staff perspectives on changing processes in general practice.

Design & setting: Mixed methods (patient survey, staff focus groups) in a sample of 22 general practices in England, varied by size, region, deprivation, demography, 2022.

Method: An online survey was delivered by sms text to adult patients at 21 practices. Data from answers to an open question about patients' experiences were analysed using summative content and thematic analysis. Virtual focus groups conducted with four categories of staff (general practitioners, nurses, receptionists & administrators, practice managers) covered team working, roles, patient interactions, adapting to change and workload. Data were transcribed and analysed using framework and thematic methods. Themes common to patients and staff were identified.

Results: Overall median survey response was 10.9%, IQR 9.7%, 14.6%; 14 401 patient respondents provided 10 348 comments, 51.2% were positive. Patient and staff perspectives overlapped in two areas: contact and communication encapsulating differing views around access, and the roles of receptionists. Patients reported barriers to getting timely appointments with their chosen professional whilst staff were seeking ways to manage the volume of communications. Use of non-clinical staff to triage appointment requests was unpopular with patients and receptionists felt clinically unqualified.

Conclusions: Effective methods are needed to improve patient communication with practices and access. Receptionists require recognition and training for their pivotal role.