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

This project focuses on understanding how transforming primary care provision is perceived and
experienced by the public.
In the context of high proportions of clinically unnecessary attendances at A&E, understanding why
patients make decisions to access emergency services is important to inform interventions that
reduce overloaded primary care provision. The proposed research explores the motivating
conditions and sense-making activities that influence patients' attendances and experiences at
primary care sites. The project will also examine how patients' situated encounters with primary
care services shape perceptions of local health policy amongst a wider backdrop of systemic
changes 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 provision
requirements in response to escalating public demand and financial pressures, ensuring patients
with 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 hospital
attendance, and provide more accessible care at lower cost.
Clinically unnecessary attendances at A&E are a concern. Recent reports suggest they account for
up to 40% of presentations at A&E, with approximately 11% of patients discharged without
treatment (NHS Digital, 2017). A recent review of patients' unnecessary use of emergency services
presents a complex situation, linked to patient frustrations with attempts to obtain a GP
appointment, coupled with perceptions that A&E attendance is a lower effort, less risky and swifter
way of receiving treatment (O'Caithin et al, 2019). There is evidence of higher rates of unnecessary
attendance by certain groups (children aged <5, adults aged >65, women, those from
socioeconomically deprived areas, with chronic diseases or mental health problems), suggesting
issues of health equity (Foster et al, 2020).