Staff perceptions on patient motives for attending GP-led urgent care centres in London: a qualitative study

Abstract

ObjectivesGeneral practitioner (GP)-led urgent care centres were established to meet the growing demand for urgent care. Staff members working in such centres are central in influencing patients’ choices about which services they use, but little is known about staff perceptions of patients’ motives for attending urgent care. We hence aimed to explore their perceptions of patients’ motives for attending such centres.DesignA phenomenological, qualitative study, including semistructured interviews. The interviews were analysed using thematic content analysis.Setting2 GP-led urgent care centres in 2 academic hospitals in London.Participants15 staff members working at the centres including 8 GPs, 5 emergency nurse practitioners and 2 receptionists.ResultsWe identified 4 main themes: ‘Confusion about choices’, ‘As if increase of appetite had grown; By what it fed on’, ‘Overt reasons, covert motives’ and ‘A question of legitimacy’. The participants thought that the centres introduce convenient and fast access for patients. So convenient, that an increasing number of patients use them as a regular alternative to their community GP. The participants perceived that patients attend the centres because they are anxious about their symptoms and view them as serious, cannot get an appointment with their GP quickly and conveniently, are dissatisfied with the GP, or lack self-care skills. Staff members perceived some motives as legitimate (an acute health need and difficulties in getting an appointment), and others as less legitimate (convenience, minor illness, and seeking quicker access to hospital facilities).ConclusionsThe participants perceived that patients attend urgent care centres because of the convenience of access relative to primary care, as well as sense of acuity and anxiety, lack self-care skills and other reasons. They perceived some motives as more legitimate than others. Attention to unmet needs in primary care can help in promoting balanced access to urgent care.

Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why?

“…First, from a health provider perspective, alternative models of care have been studied within EDs, including minor injury or ‘fast-track’ units staffed by nurse practitioners and GPs managing non-urgent problems either in collocated clinics or within EDs themselves 21–23. In the UK, external urgent care centres have been introduced to try to alleviate the pressure on EDs with varying utilisation 24. A Cochrane review of three observational studies comparing GPs and emergency physicians managing non-urgent presentations reported that GPs ordered fewer blood tests and X-rays but that the overall quality of evidence was weak 22.…”

“…[21][22][23] In the UK, external urgent care centres have been introduced to try to alleviate the pressure on EDs with varying utilisation. 24 A Cochrane review of three observational studies comparing GPs and emergency physicians managing non-urgent presentations reported that GPs ordered fewer blood tests and X-rays but that the overall quality of evidence was weak. 22 Similarly, there is paucity of evidence relating to nurse practitioners with respect to costeffectiveness and quality of care, although several studies have shown improved patient satisfaction in minor injury unit settings.…”

Sense-making strategies and help-seeking behaviours associated with urgent care services: a mixed-methods study

“…They simply want someone to see them'. 114 They also reported that staff believed that patients used the UCC because it was convenient or because they had difficulties accessing other services (e.g. GP appointments).…”

‘Clinically unnecessary’ use of emergency and urgent care: A realist review of patients' decision making

“…Judgements about the clinical necessity of demand may be shaped by the supply of services, where these judgements become harsher as demand outstrips supply. Staff judgements regarding legitimate reasons for service use may also vary between individual clinicians and individual services …”