Advancing an understanding of access as ‘human fit’: A qualitative participatory case study in general practice

Background: Good access to primary care is an important determinant of population health. Whilst the academic literature on access to care emphasises its complexity, policies aimed at improving access to general practice in the UK have tended to focus on measurable aspects, such as timeliness or number of appointments. Aim: To fill the gap between the complex understanding of primary care access in the literature and the narrow definition of access assumed in UK policies. Design and Setting: Qualitative, community-based participatory case study within the geographic footprint of a Clinical Commissioning Group in northwest England. Method: We applied Levesque et al.’s conceptual framework of patient-centred access and used multiple qualitative methods (interviews, focus groups, observation). Analysis was ongoing, iterative, inductive, and abductive with the theory. Results: The comprehensiveness of Levesque et al.’s access theory resonated with diverse participant experiences. However, while a strength of Levesque et al. was to highlight the importance of people’s abilities to access care, our data suggest equal importance of healthcare workforce abilities to make care accessible. Thus, we present a definition of access as the ‘human fit’ between the needs and abilities of people in the population and the abilities and capacity of people in the healthcare workforce, and provide a modified conceptual framework reflecting these insights. Conclusion: An understanding of access as ‘human fit’ has the potential to address longstanding problems of access within general practice, focusing attention on the need for staff training and support, and emphasising the importance of continuity of care.