Public experiences of service change in primary care: Focusing on the spaces and places of service delivery

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This project focuses on understanding how transforming primary care provision is perceived andexperienced by the public.In the context of high proportions of clinically unnecessary attendances at A&E, understanding whypatients make decisions to access emergency services is important to inform interventions thatreduce overloaded primary care provision. The proposed research explores the motivatingconditions and sense-making activities that influence patients' attendances and experiences atprimary care sites. The project will also examine how patients' situated encounters with primarycare services shape perceptions of local health policy amongst a wider backdrop of systemicchanges to primary care provision.One of the most ambitious plans of the National Health Service (NHS) is to 'transform primary care'(NHS, 2021). The impetus for this transformation is to enable the NHS to continue to meet provisionrequirements in response to escalating public demand and financial pressures, ensuring patientswith diverse needs are met with a choice of offerings. Notable initiatives include: the non emergency "111 First" helpline, the "Pharmacy First" minor ailments campaign, and the "AskMyGP"online consultation platform, all introduced to achieve greater workforce utilisation, offset hospitalattendance, and provide more accessible care at lower cost.Clinically unnecessary attendances at A&E are a concern. Recent reports suggest they account forup to 40% of presentations at A&E, with approximately 11% of patients discharged withouttreatment (NHS Digital, 2017). A recent review of patients' unnecessary use of emergency servicespresents a complex situation, linked to patient frustrations with attempts to obtain a GPappointment, coupled with perceptions that A&E attendance is a lower effort, less risky and swifterway of receiving treatment (O'Caithin et al, 2019). There is evidence of higher rates of unnecessaryattendance by certain groups (children aged <5, adults aged >65, women, those fromsocioeconomically deprived areas, with chronic diseases or mental health problems), suggestingissues of health equity (Foster et al, 2020).