title: Improving access to primary care: eight case studies of introducing Advanced Access in England.
abstract: OBJECTIVE
  To examine the implementation of 'Advanced Access' as a means of improving access to primary care.
  
  
  METHODS
  Qualitative case studies of eight English general practices undertaken as part of a mixed method study.
  
  
  RESULTS
  There was considerable variation in the interpretation and implementation of Advanced Access. Practices claiming to operate this system often did not follow its key principles. Differences between practice access systems centred on the use of 'same-day' appointments. The association of Advanced Access with same-day appointment systems was problematic as it both created antagonism to, and diverged from, the Advanced Access model. Practice staff did not necessarily share the conceptualisation of demand that underpinned Advanced Access. Other policies and targets provided further incentives to diverge from the model and these factors were compounded by informal organizational behaviours, notably the exercise of discretion, which led to adaptation.
  
  
  CONCLUSIONS
  Advanced Access was diluted because it became confused with same-day appointment systems and other incentives and targets. Its guiding philosophy of 'manageable demand' appeared counter-intuitive to staff in the context of general practice, which made its implementation problematic. As a result, the system was adapted and modified.
authors.affiliation: School of Nursing & Midwifery, University of Southampton, Southampton, UK. cjp@soton.ac.uk
authors.forename: Catherine
authors.initials: C
authors.lastname: Pope
authors.forename: Jon
authors.initials: J
authors.lastname: Banks
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
authors.forename: Val
authors.initials: V
authors.lastname: Lattimer
mesh_terms: D004739:England; D005194:Family Practice; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D019982:Organizational Case Studies; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013222:State Medicine