title: A qualitative study of the impact of the implementation of advanced access in primary healthcare on the working lives of general practice staff.
abstract: BACKGROUND
  The North American model of 'advanced access' has been emulated by the National Primary Care Collaborative in the UK as a way of improving patients' access in primary care. The aim of this study was to explore the impact of the implementation of advanced access on the working lives of general practice staff.
  
  
  METHODS
  A qualitative study design, using semi-structured interviews, was conducted with 18 general practice staff: 6 GPs, 6 practice managers and 6 receptionists. Two neighbouring boroughs in southeast England were used as the study sites. NUD*IST computer software assisted in data management to identify concepts, categories and themes of the data. A framework approach was used to analyse the data.
  
  
  RESULTS
  Whilst practice managers and receptionists saw advanced access as having a positive effect on their working lives, the responses of general practitioners (GPs) were more ambivalent. Receptionists reported improvements in their working lives with a change in their role from gatekeepers for appointments to providing access to appointments, fewer confrontations with patients, and greater job satisfaction. Practice managers perceived reductions in work stress from fewer patient complaints, better use of time, and greater flexibility for contingency planning. GPs recognised benefits in terms of improved consultations, but had concerns about the impact on workload and continuity of care.
  
  
  CONCLUSIONS
  AA has improved working conditions for receptionists, converting their perceived role from gatekeeper to access facilitator, and for practice managers as patients were more satisfied. GP responses were more ambivalent, as they experienced both positive and negative effects.
authors.affiliation: Watling Medical Centre, 108 Watling Avenue, HA8 0NR, London, UK. sanjivahluwalia@btinternet.com
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Ahluwalia
authors.forename: Maxine
authors.initials: M
authors.lastname: Offredy
mesh_terms: D000288:Administrative Personnel / Q000523:psychology; D000328:Adult; D001291:Attitude of Health Personnel; D004739:England; D005194:Family Practice / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007588:Job Satisfaction; D008496:Medical Receptionists / Q000523:psychology; D008875:Middle Aged; D033262:Narration; D009740:Nursing Staff / Q000523:psychology; D010821:Physicians, Family / Q000523:psychology; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D000078329:Workforce; D016526:Workload / Q000523:psychology