The Reported Availability of General Practitioners and the Influence of Practice List Size

Background: Combined practice list sizes have increased, but larger practice size may be associated with disadvantage to patients.

Aim: The aim of the study was to investigate the availability of general practitioners as reported by their patients and the relationship between reported availability and practice list size.

Method: A one-week questionnaire survey of 8315 patients attending participating practices in West Lothian, Scotland, was conducted. Patients were asked about the arrangements for being seen at that attendance, their perception of doctor availability following an urgent or non-urgent consultation request, and their social and demographic characteristics. The proportion of respondents reporting they could see a doctor the same day following an urgent consultation request or within 2 days following a non-urgent consultation request was determined for each practice.

Results: Eighteen out of 26 practices agreed to participate in the study, and an overall response rate of 61% was obtained in the patient survey. Participating practices were representative of all practices in the area with regard to list size; questionnaire respondents were representative of the age profile of participating practices and were representative of the local general population with regard to car and home ownership. There was a wide variation among practices in the proportion of questionnaire respondents who reported that a doctor was available within 2 days following a non-urgent consultation request [mean 60.7 (SE 7.1%)], but less variation for the reported availability on the same day after an urgent consultation request [mean 81.1 (SE 2.3 %)]. A significant negative association was demonstrated between combined practice list size and reported non-urgent or urgent availability.

Conclusion: Wide variation exists between practices with regard to patients' perceptions of doctor availability, and smaller practices may have advantages in this regard. The feelings and perceptions of patients should be taken into account when planning or reviewing the delivery of primary health care.