Investigating the impact of distance on the use of primary care extended hours

Introduction Poor access to general practice services has been attributed to increasing pressure on the health system more widely and low satisfaction among patients. Recent initiatives in England have sought to expand access by the provision of appointments in the evening and at weekends. Services...

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Autores principales:	Jen Murphy, Mark Elliot, William Whittaker, Rathi Ravindrarajah
Formato:	article
Lenguaje:	EN
Publicado:	Swansea University 2021
Materias:	Demography. Population. Vital events HB848-3697
Acceso en línea:	https://doaj.org/article/c5f8128d2a084ee1b560d977844b68af
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spelling	oai:doaj.org-article:c5f8128d2a084ee1b560d977844b68af2021-12-03T15:47:29ZInvestigating the impact of distance on the use of primary care extended hours10.23889/ijpds.v6i1.14012399-4908https://doaj.org/article/c5f8128d2a084ee1b560d977844b68af2021-10-01T00:00:00Zhttps://ijpds.org/article/view/1401https://doaj.org/toc/2399-4908 Introduction Poor access to general practice services has been attributed to increasing pressure on the health system more widely and low satisfaction among patients. Recent initiatives in England have sought to expand access by the provision of appointments in the evening and at weekends. Services are provided using a hub model. NHS national targets mandate extended opening hours as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. However, research has shown that other factors affect access to healthcare and it may not simply be appointment availability that limits an individual's ability to access general practice services. Objectives To determine whether distance and deprivation impact on the uptake of extended hours GP services that use a hub practice model. Methods We linked a dataset (N = 25,408) concerning extended access appointments covering 158 general practice surgeries in four Clinical Commissioning Groups (CCGs) to the General Practice Patient Survey (GPPS) survey, deprivation statistics and primary care registration data. We used negative binomial regression to estimate associations between distance and deprivation on the uptake of extended hours GP services in the Greater Manchester City Region. Distance was defined as a straight line between the extended hours provider location and the patient's home practice, the English Indices of Multiple Deprivation were used to determine area deprivation based upon the home practice, and familiarity was defined as whether the patient's home practice provided an extended hours service. Results The number of uses of the extended hours service at a GP practice level was associated with distance. After allowing for distance, the number of uses of the service for hub practices was higher than for non-hub practices. Deprivation was not associated with rates of use. Conclusion The results indicate geographic inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub and spoke model does not address barriers to access. Findings may help to inform the choice of hub practices when designing an extended access service. Providers should consider initiatives to improve access for those patients located in practices furthest away from hub practices. This is particularly of importance in the context of closing health inequality gaps. Jen MurphyMark ElliotWilliam WhittakerRathi RavindrarajahSwansea UniversityarticleDemography. Population. Vital eventsHB848-3697ENInternational Journal of Population Data Science, Vol 6, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Demography. Population. Vital events HB848-3697
spellingShingle	Demography. Population. Vital events HB848-3697 Jen Murphy Mark Elliot William Whittaker Rathi Ravindrarajah Investigating the impact of distance on the use of primary care extended hours
description	Introduction Poor access to general practice services has been attributed to increasing pressure on the health system more widely and low satisfaction among patients. Recent initiatives in England have sought to expand access by the provision of appointments in the evening and at weekends. Services are provided using a hub model. NHS national targets mandate extended opening hours as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. However, research has shown that other factors affect access to healthcare and it may not simply be appointment availability that limits an individual's ability to access general practice services. Objectives To determine whether distance and deprivation impact on the uptake of extended hours GP services that use a hub practice model. Methods We linked a dataset (N = 25,408) concerning extended access appointments covering 158 general practice surgeries in four Clinical Commissioning Groups (CCGs) to the General Practice Patient Survey (GPPS) survey, deprivation statistics and primary care registration data. We used negative binomial regression to estimate associations between distance and deprivation on the uptake of extended hours GP services in the Greater Manchester City Region. Distance was defined as a straight line between the extended hours provider location and the patient's home practice, the English Indices of Multiple Deprivation were used to determine area deprivation based upon the home practice, and familiarity was defined as whether the patient's home practice provided an extended hours service. Results The number of uses of the extended hours service at a GP practice level was associated with distance. After allowing for distance, the number of uses of the service for hub practices was higher than for non-hub practices. Deprivation was not associated with rates of use. Conclusion The results indicate geographic inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub and spoke model does not address barriers to access. Findings may help to inform the choice of hub practices when designing an extended access service. Providers should consider initiatives to improve access for those patients located in practices furthest away from hub practices. This is particularly of importance in the context of closing health inequality gaps.
format	article
author	Jen Murphy Mark Elliot William Whittaker Rathi Ravindrarajah
author_facet	Jen Murphy Mark Elliot William Whittaker Rathi Ravindrarajah
author_sort	Jen Murphy
title	Investigating the impact of distance on the use of primary care extended hours
title_short	Investigating the impact of distance on the use of primary care extended hours
title_full	Investigating the impact of distance on the use of primary care extended hours
title_fullStr	Investigating the impact of distance on the use of primary care extended hours
title_full_unstemmed	Investigating the impact of distance on the use of primary care extended hours
title_sort	investigating the impact of distance on the use of primary care extended hours
publisher	Swansea University
publishDate	2021
url	https://doaj.org/article/c5f8128d2a084ee1b560d977844b68af
work_keys_str_mv	AT jenmurphy investigatingtheimpactofdistanceontheuseofprimarycareextendedhours AT markelliot investigatingtheimpactofdistanceontheuseofprimarycareextendedhours AT williamwhittaker investigatingtheimpactofdistanceontheuseofprimarycareextendedhours AT rathiravindrarajah investigatingtheimpactofdistanceontheuseofprimarycareextendedhours
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Investigating the impact of distance on the use of primary care extended hours

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