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

本项目的重点是了解公众如何看待和体验初级保健服务的转变。在急诊室高比例的临床不必要就诊的背景下，了解患者为什么决定接受急诊服务对于减少超负荷初级保健服务的干预措施非常重要。拟议的研究探讨了激励条件和意义的活动，影响病人的出勤率和经验，在初级保健网站。该项目还将研究患者与初级保健服务的接触如何在初级保健提供系统性变化的更广泛背景下塑造对当地卫生政策的看法。国家卫生服务（NHS）最雄心勃勃的计划之一是“改造初级保健”（NHS，2021）。这一转变的动力是使NHS能够继续满足供应要求，以应对不断升级的公共需求和财政压力，确保具有不同需求的患者能够选择产品。值得注意的举措包括：非紧急的“111急救”电话、“药房优先”小病运动和“AskMyGP“网上咨询平台，都是为了提高劳动力利用率，抵消住院费用，并以更低的成本提供更容易获得的护理。最近的报告表明，他们占A&E的40%，大约11%的患者未经治疗出院（NHS Digital，2017）。最近对患者不必要地使用急诊服务的审查呈现出一种复杂的情况，与患者对尝试获得GP预约的挫折感有关，再加上认为A&E出勤是一种较低的努力，风险较低，接受治疗的方式也较简单（O'Caithin et al，2019）。有证据表明，某些群体（5岁以下儿童、65岁以上成年人、妇女、来自社会经济贫困地区、患有慢性病或精神健康问题的人）的非必要就诊率较高，这是健康公平性的突出问题（Foster等人，2020年）。

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).