Evaluation of advanced access in the national primary care collaborative.

BACKGROUND An aim of the National Primary Care Collaborative is to improve quality and access for patients in primary care using principles of Advanced Access. AIMS To determine whether Advanced Access led to improved availability of appointments with general practitioners (GPs) and to examine GPs' views of the process. DESIGN Observational study. SETTING Four hundred and sixty-two general practices in England participating in four waves of the collaborative during 2000 and 2001. METHOD Regression analysis of the collaborative's monthly data on the availability of GP appointments for the 352 practices in waves 1-3, and a postal survey of lead GPs in all four waves. The main outcome measures were the change in mean time to the third available appointment with GPs, and the proportion of GPs thinking it worthwhile participating in the collaborative. RESULTS The time to the third available appointment improved from a mean of 3.6 to 1.9 days, difference = 1.7 days, 95% confidence interval (CI)= 1.4 to 2.0 days. It improved in two-thirds of practices (66% [219/331]), remained the same in 16% (53/331), and worsened in 18% (59/331). The majority of GPs in all four waves, 83% (308/371, 95% CI = 79 to 87), felt that it was worthwhile participating in the collaborative, although one in 12 practices would not recommend it. One-fifth of GPs cited a lack of resources as a constraint, and some expressed concerns about the trade-off between immediate access and continuity of care. CONCLUSION Advanced Access helped practices to improve availability of GP appointments, and was well received by the majority of practices.