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Using Geographic Information Systems to Investigate Variations in Accessibility to ‘Extended Hours’ Primary Healthcare Provision

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Using Geographic Information Systems to Investigate Variations in Accessibility to ‘Extended Hours’ Primary Healthcare Provision Received: 23 March 2018 | Revised: 20 December 2018 | Accepted: 15 January 2019 DOI: 10.1111/hsc.12724 ORIGINAL ARTICLE Using Geographic Information Systems to investigate variations in accessibility to ‘extended hours’ primary healthcare provision Gary Higgs1 | Mitchel Langford1 | Paul Jarvis1 | Nicholas Page1 | Jonathan Richards2 | Richard Fry3 1GIS Research Centre, Wales Institute of Social and Economic Research, Data and Abstract Methods (WISERD), University of South There are ongoing policy concerns surrounding the difficulty in obtaining timely ap‐ Wales, Pontypridd, UK pointments to primary healthcare services and the potential impact on, for example, 2Faculty of Life Sciences and Education, University of South Wales, attendance at accident and emergency services and potential health outcomes. Using Pontypridd, UK the case study of potential access to primary healthcare services in Wales, Geographic 3Farr Institute, College of Medicine, Institute Information System (GIS)‐based tools that permit a consideration of population‐to‐ of Life Science 2 (ILS2), Swansea University, Swansea, UK provider ratios over space are used to examine variations in geographical accessibil‐ ity to general practitioner (GP) surgeries offering appointment times outside of ‘core’ Correspondence Gary Higgs, GIS Research Centre, Wales operating hours. Correlation analysis is used to explore the association of accessibil‐ Institute of Social and Economic Research, ity scores with potential demand for such services using UK Population Census data. Data and Methods (WISERD), University of South Wales, Pontypridd, UK. Unlike the situation in England, there is a tendency for accessibility to those surgeries Email: [email protected] offering ‘extended’ hours of appointment times to be better for more deprived cen‐ Funding information sus areas in Wales. However, accessibility to surgeries offering appointments in the Economic and Social Research Council, evening was associated with lower levels of working age population classed as ‘eco‐ Grant/Award Number: ES/L009099/1 nomically active’; that is, those who could be targeted beneficiaries of policies geared towards ‘extended’ appointment hours provision. Such models have the potential to identify spatial mismatches of different facets of primary healthcare, such as ‘ex‐ tended’ hours provision available at GP surgeries, and are worthy of further investi‐ gation, especially in relation to policies targeted at particular demographic groups. KEYWORDS extended hours of provision, general practitioners, primary healthcare, spatial accessibility, two‐step floating catchment area (2SFCA) models 1 | INTRODUCTION ability to see a preferred general practitioner (GP), ability to a get a routine appointment and convenience of surgery opening hours, Timely access to primary healthcare services has been identified in has also been associated with an increased use of out‐of‐hours a number of studies as a contributory factor influencing patient de‐ primary care services (Zhou et al., 2014) and a greater likelihood cisions to self‐refer to secondary care (Flores‐Mateo, Violan‐Fors, of both hospital admission and accident and emergency (A&E) at‐ Carillo‐Santisteve, Peiro, & Argimon, 2012; Huntley et al., 2014; tendance (O’Malley, 2013). With regard to the latter, in England in Kraaijvanger, Leeuwen, Rijpsma, & Edwards, 2016). Poorer in‐hours 2012–2013, it was estimated that a quarter of A&E attendances access, measured as the ease of getting through on the telephone, (amounting to 5.8 million patients) were made by persons who had 1074 | © 2019 John Wiley & Sons Ltd wileyonlinelibrary.com/journal/hsc Health Soc Care Community. 2019;27:1074–1084. HIGGS ET AL. | 1075 failed to obtain a convenient appointment with their GP (Cowling, Harris, Watt, Gibbons, & Majeed, 2014). Similarly, 7‐day GP surgery What is known about this topic opening has been shown to reduce attendance at A&E departments by 9.9% overall and by 17.9% at weekends in pilot surgeries (Dolton • Access to primary care needs to be considered in rela‐ & Pathania, 2016). tion to other aspects of health provision. The General Medical Services (GMS) contract, a UK‐wide con‐ • GIS has been used to examine variations in geographical tract between the majority of GP surgeries and the NHS organ‐ access to primary healthcare. isations in each of the respective countries (i.e. England, Wales, • Recent UK Governments have emphasised the need for Scotland and Northern Ireland), stipulates the form of primary care extended hours of provision for GP appointments. services delivered to patients (these are replaced by locally nego‐ tiated contracts in just over a third of surgeries in England where What this paper adds service provision is geared towards meeting local needs: House of • Network‐based accessibility maps highlight the current Commons Library, 2018). As of March 2017, the GMS contract stip‐ state of extended hours provision in Wales. ulates that the opening hours of GP surgeries (Monday–Friday) are • This analysis can be used to compare provision for those in place from 8 a.m. to 6.30 p.m. (so‐called ‘core’ hours), excluding groups who could typically avail themselves of such pro‐ bank holidays. However, some surgeries may not be open through‐ vision in evenings and at weekends. out these hours nor necessarily offer the opportunity to make ap‐ • These tools should inform future policy concerning the pointments within these hours – for example, a recent report by the collaborative delivery of services and the exact choice National Audit Office found that 46% of surgeries in England were of surgeries or hubs selected for extended access closed at some point during these core hours (National Audit Office provision. [NAO], 2017). In England and Wales, there has been a policy impetus to extend the opening hours available for appointments. In England, for ex‐ ample, a number of NHS initiatives such as the GP Access Fund (pro‐ to the June 2017 UK General Election between those who advo‐ viding monies across two waves to help improve access to general cate that GP surgeries in the UK should be offering patients same practice) and the GP Forward View (a 5‐year plan for general practice day, emergency access appointments in order to alleviate pres‐ published in April 2016) aim to ensure that, by 2020, ‘everyone has sures on NHS departments and those groups who question the access to GP services, including sufficient routine appointments at clinical and cost‐effectiveness of extended operating hours, has evenings and weekends to meet locally determined demand, along‐ drawn attention to the need for more research on potential in‐ side effective access to out‐of‐hours (OoH) and urgent care services’ equalities in primary care provision. However, despite concerns (NHS England, 2016, p. 47). There is also a widening evidence base regarding a shortage of GPs in the UK, few UK‐based studies concerning extended access schemes and potential impacts on A&E have investigated detailed patterns of GP availability in relation attendance. to potential demand in order to identify any spatial mismatches Recent studies have involved both regional (e.g. Greater between provision and needs. Manchester evaluation; NIHR CLAHRC, 2015; Whittaker et al., Geographical Information Systems (GIS) are increasingly being 2016) and national (England) evaluations of moves towards ex‐ used to examine potential inequity in levels of accessibility to pri‐ tended hours provision (Mott MacDonald & SQW, 2016). The latter mary care services (DeWulf, Neutens, Weerdt, & Weghe, 2013; study involved an evaluation of the early impacts of the Access Fund Higgs, Zahnow, Corcoran, Langford, & Fry, 2017; Yang, Goerge, & programme and included an appraisal of those objectives geared to‐ Mullner, 2006) and associations with neighbourhood demographic wards providing additional extended hours of GP appointment time, characteristics (Bissonnette, Wilson, Bell, & Shah, 2012; Hyndman changes in appointments during core operating hours through, for & Holman, 2001; Ye & Kim, 2015). Previous studies have also shown, example, collaborative working across surgeries and the impacts for example, how different GIS‐based metrics can be used to un‐ on reducing demand elsewhere in the system. However, nationally, derstand the potential contribution of physical access to primary there remain concerns with regard to booking appointments outside care on the use of emergency departments for different medical of ‘normal’ working hours: 10% of patients registered in England live conditions (Fishman, McLafferty, & Galanter, 2018; Ludwick, F, R., in areas where there is no evening or weekend access (BBC, 2018a), Warden, C., & Lowe, R.A., 2009; Teach et al., 2006). In Wales, there and only a quarter of GP surgeries in Wales offer appointments up is currently a lack of understanding of existing spatial patterns in to 6.30 p.m. twice a week (BBC, 2018b). extended hours provision; information that could inform whether Research that explores the geographical availability of pri‐ and where a targeted extended hours service could be located. mary care provision, as part of wider studies of the effectiveness Thus, drawing on GIS‐based techniques, this study has two prin‐ of extended access to primary care services for improving health cipal aims: firstly to explore the extent of spatial variation in levels outcomes or reducing inappropriate attendance at other health of accessibility to GP surgeries that offer ‘extended’ hours of ap‐
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