Impact of Advanced Access on access, workload, and continuity: controlled before-and-after and simulated-patient study.

Chris Salisbury, Alan A Montgomery, Lucy Simons, Fiona Sampson, Sarah Edwards, Helen Baxter, Stephen Goodall, Helen Smith, Val Lattimer, D Mark Pickin

Case studies from the US suggest that Advanced Access appointment systems lead to shorter delays for appointments, reduced workload, and increased continuity of care. To determine whether implementation of Advanced Access in general practice is associated with the above benefits in the UK. Controlled before-and-after and simulated-patient study. Twenty-four practices that had implemented Advanced Access and 24 that had not. Anonymous telephone calls were made monthly to request an appointment. Numbers of appointments and patients consulting were calculated from practice records. Continuity was determined from anonymised patient records. The wait for an appointment with any doctor was slightly shorter at Advanced Access practices than control practices (mean 1.00 day and 1.87 days respectively, adjusted difference -0.75; 95% confidence interval [CI] = -1.51 to 0.004 days). Advanced Access practices met the NHS Plan 48-hour access target on 71% of occasions and control practices on 60% of occasions (adjusted odds ratio 1.61; 95% CI = 0.78 to 3.31; P = 0.200). The number of appointments offered, and patients seen, increased at both Advanced Access and control practices over the period studied, with no evidence of differences between them. There was no difference between Advanced Access and control practices in continuity of care (adjusted difference 0.003; 95% CI = -0.07 to 0.07). Advanced Access practices provided slightly shorter waits for an appointment compared with control practices, but performance against NHS access targets was considerably poorer than officially reported for both types of practice. Advanced Access practices did not have reduced workload or increased continuity of care.