Introduction to Research Methodologies - National Health Services

Research Project Title- Improving Access to General Practice

General practice is the work of a doctor who is based in the community and treats patients with minor or chronic illnesses and refers those with serious conditions to a hospital. The practitioners who are giving general practice treat all the common medical conditions as well as refer patients to hospitals and other medical services for urgent and specialist treatment. The complete health of patients includes physical, social, and psychological aspects of the case focused by these practitioners (Burwell, 2015). It is a very emerging topic in the United Kingdom as people are facing many issues regarding the general practices and this is the reason for the selection of the topic. The role played by general practitioners is very essential as people living in societies depend on them. They play a vital role in promoting, preventing as well as initiating the treatment of people. In the United Kingdom, there are more than 1.3 million general practice consultations each day, most of which take place in GP surgery or within the family of patients. In the UK, the working hours of General Practice doctors are very long and they are facing issues of workload which in turn affects the quality services of the practitioners. The patients are not satisfied with the general practitioners of UK.

Research Problem

It is a far-flung study that people are finding it more difficult to access their general practice. The practitioners are under growing pressure as an upshot of an increase in the volume as well as the intensity of their work. There has been a monolithic increase in demand for the services. Similarly, fewer General practitioners are choosing to undertake full-time clinical work in general practice whereas a huge number of people are retiring as well as leaving the profession (Coulter and et.al.,  2014). The most common complaint regarding general practice is about access.  An inaccessible system of primary care will necessarily outcome in patient's health being amused to emergency services and out-of-hour care centres, causing more strain on a pool of limited resources. Practitioners are managing critical cases as well as providing services to patients but still it is not appropriate as patients are not satisfied. An investigation of primary care related to accessibility, effectiveness as well as continuity is essential to maintain high levels of patient satisfaction.

Research Aim and Objectives

Aim- “ To assess the ways of improving access to General Practice by reducing their urgent care centre attendance”. A study on National Health Service (NHS) organisation.

Objectives

• To study the main nationwide complaints regarding GP access.
• To gain insight into the day-to-day problems that are being experienced by the patients to access GP.
• To critically analyse the changes that are required at a daily running of GP practices (at a managerial level), to widen the access for patients by together enhancing their overall experience.

LITERATURE REVIEW

The main nationwide complaints regarding GP access.

According to Andersen, Davidson and Baumeister, (2014) competition is also rising among the general practices. General practice is the work of a doctor who is based in the community and treats patients with minor or chronic illnesses and refers those with serious conditions to a hospital. It has been identified that General practices are falling short of what is needed by both the Complain Regulations 2009. This complaint is made to improve the quality of services by taking strict actions. The main national wide complaint regarding the General practices access as services they are providing in the UK is not satisfying the needs as well as they are providing quality services because of heavy workload and long timing issues. These are the main issues and complaints regarding access to general practices. Author said that Bibbins-Domingo, (2016)  the complaints are day to day increasing because of increasing the expectations of quality as well as transparency in health care from patients.  It is managing raising complex cases within society but similarly, the demand of people for health services is also changing. Patients complain of trouble in managing to make appointments, practitioners of General practices as well as complain of low morale and politicians complain that surgeries are not open for long enough. Furthermore, demand for an evermore-accessible GP keeps expanding as the population continues to grow and patients live longer with more complex needs.

Gain insight into the day-to-day problems that are being experienced by the patients to access GP.

According to Betancourt, (2016) Healthcare industry is the most important industry of any economy or country. General practices are one of the most important parts of the healthcare industry. Patients are experiencing trouble accessing general practices in emergency time as well as they are also facing difficulties in accessing quality of services. In addition to this, the practitioners or doctors of general practices are responsible for providing good quality care for a range of high prevalences of chronic disease at the same time by providing continuity of care. It has been reported that more than 75% of people or patients does not able to meet the optimal standard of services. There are various reasons why patients are facing issues and difficulties in accessing quality of healthcare because of lack of resources, funds, limited engagement, lack of information and many other and all these affects the quality of care. Author stated that Gillies, Kinahan, and Hricak, (2015) Apart from this, not only patients, doctors are also facing challenges and issues in providing treatment to patients such as long timing and the stress of work and it affecting the services in quality of services. Furthermore, because of long times or workload and any other issues of practitioners in GP are also affecting their health as well as their lives of people. They are not taking proper medicines and drugs which also affects the health of patients as they are not recovering fast and possible. As per Pecora and et.al., (2017) they are not accessing cost-effective care which is also one of the issues that they are experiencing. 85% of patients are were able to get an appointment on their previous attempt; two years previously this number was 87% according to the survey. Furthermore. The very popular ongoing issues, like trouble in booking appointments, appointment systems increase frustration, rushed appointments, lack of choice of GP, inadequate information for people to steer the systems of health as well as insufficient information about out-of hours service. Thus, a good and better access is when patients can easily and quickly get appointments they required.  

Changes that are required at daily running of GP practices (at a managerial level), to widen the access for patients by together enhancing their overall experience.

According to Mackey and Gass, (2015) General practices is very important part of the healthcare industry. Thus, it is very important to solve the issues in General practices that are affecting the health as well as the life of patients. A good access of GP is when a person can reach and obtain the services 24 hours. Changes should be implemented so that people or patients can be satisfied with the services they are offering. The Department of health in the UK introduced a policy and strategies to address the quality of accessibility as well as guarantee access within 48 hours as they introduced the framework of Quality and Outcomes in 2004 which focused on and established a system of providing services in out of hours. Healthcare organisations have started to implement changes so that patients can access to GP whenever they need as they introduce some other systems of provision like walk-in centres, and helplines so that any person who urgently needs or requires treatments. Burwell, (2015) said that, healthcare organisations has also extended the hours of opening, and developed new practices in all areas where people are getting low and fewer services and care. The healthcare organizations face the problem of funding in projects £70 billion. Primary care plays a key role in assisting to cut down this gap by giving extra personalised, accessible society-based services for patients to improve society's health and reduce avoidable pressures on hospital resources. This will affect the manner of care that is provided and the precedence the services that need and want of patients within the accessible resources and funds. In addition to this, healthcare organisations should increase the workforce so that day-to-day problems that are being experienced by the patients to access GP easily and quickly.  

Research Methodologies

Research methodology is the systematic, theoretical analysis of methods that are applied to investigate the study. This is the proper plan for conducting the research. Here are the methods which are used by the researcher to assess the ways of improving access to General Practice by reducing their urgent care centre attendance.

Research Approach- It is the overall design that is used by the researcher to study the specific topic. It is the systematic plan as well as process that span the steps from broad assumption to exploring the methods of data collection and interpretation. Several decision and there need to make the sense of report are included in the research approach. The entire study presented with the help of research approach. There are two types of research approach which are qualitative and quantitative. In this present research researcher has used both qualitative and quantitative approach to study the problem of research and to identify ways of improving access to General Practice by reducing their urgent care centre attendance (Mackey and Gass, 2015). With the help of quantitative research, researchers has used to explore as well as understand the main problem of research. Whereas, quantitative research approach is used in order to test the objectives of theories by determining the relationship among the variables.

Data Collection- This is the vital part of research methodology. It is the process of gathering as well as measuring the data or information on variables of interest in a well-defined manner to find the answer of the research. There are tow methods of collecting data which are primary and secondary. Primary methods of collecting data included the data which are collected by the researcher by his/her own efforts such as survey, questionnaire, and interview while the secondary collection of data includes collection of data from other sources such as books, journals, internet articles, etc. Primary data is unused and fresh data whereas secondary data is used and second hand data. The integrity of the research cannot be maintained without the collection of data. The reliability is much more in primary data as compared to secondary sources. The accuracy is also high in the collection of primary collection of data as compared to secondary data. The nature of primary collection methods is original but secondary has duplicate in nature. In this present research, the researcher has collected from both sources and identified ways of improving access to General Practice by reducing urgent care centre attendance. The researcher has prepared a questionnaire and collected the data from patients (Taylor, Bogdan and DeVault, 2015).  

Data Analysis- It is also one of the most essential parts of research methodology. Data analysis is the process of examining, cleaning, transforming as well as modeling information with the purpose of discovering useful data. Without data analysis, research is meaningless, thus it is very important that data and information should be cleaned before presentation. In this present research, the researcher has used the primary method of collecting data by using thematic analysis. With the help of thematic analysis, scholars can interpret the data by identifying ways of improving access to General Practice by reducing their urgent care centre attendance.

Sampling- This is another most essential part of research methodology. The well-defined and systematic process of selecting a small group of people from a large population. It is not possible for the researcher to collect the data from large population so in order to overcome this problem, the researcher has selected a small group of people. In this present research, the researcher has collected data from patients who have recently visited an out-of-hours or emergency department of the National Health Service Organisation (NHS) during normal practice hours (Lewis, 2015).

Ethical Consideration- Ethical consideration is also an essential part that researchers have to follow in any manner. This is because if the researcher does not consider ethics, norms, and standards then research will be useless. There are numerous ethical considerations that the Researcher in this present research has considered as follows-

• All patients are involved in the focus group with informed consent.
• All patients are given chances to leave the group if required.
• Privacy of data has also been maintain (Vaioleti, 2016)
• Patient responses have been managed securely and any data will be kept on-site at the GP surgery.

Finding

Theme 1: Maximum patients have been using the services of NHS for 4-6 years.

Theme 2: Patients are not satisfied with the services of the National Healthcare Services (NHS) organisation.

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Theme 3: Difficulty in Booking Appointments is the major reason for not attending general practice. 

Theme 4: Non-availability of doctors out of hours is a major issue you are facing to access General practice.

Theme 5: NHS needs to make the balance in the shift or working hours of doctors.

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Discussion & Recommendation

Theme 1: Maximum patients are using the services of NHS since 6-8 years.

Interpretation- The above analysis conducted from the patients of NHS states that maximum patients are using the services of National healthcare services organisation (NHS) said by 9 patients. They said that they are satisfied with the services offered by NHS care givers and practitioners. On the other hand, 7 patients are using the services of  NHS since 6-8 years. They said that they face issues when they visit the hospital in late night in the emergency. Apart from this, 4 respondents are using the services of NHS by 2-4 years.

Theme 2: Patients are not satisfied with the services of National Healthcare Services (NHS) organisation.

Interpretation- The above analysis conducted from the patients of NHS states that patients are not satisfied with the services of National Healthcare Services (NHS) organisation as they said that they faces the difficulties in booking appointment which makes the dissatisfied with the services as 8 are highly satisfied. On the other hand, 2 respondents are supporting that that they are also not satisfied with the services for the same reason. It is also identified that 6 patients are highly disagree that the services offered by NHS are good and effective and they are satisfied with the services as well as 2 respondents are also not supporting as they said that they are also satisfied with the services. Furthermore, 2 patients have no answer as they are confused.

Theme 3: Difficulty in Booking Appointment is the major reason for not attending general practice.

Interpretation- The above analysis conducted by the patients of NHS states that 10 patients said that they are facing issues in booking the appointment of doctors because of work stress and lack of communication technology. On the other hand, 5 respondents said they also face trouble in booking appointments and it is because of the Inefficient appointment system in NHS. Addition to this, 3 patients lack of option to access general practices because of fewer staff members. Only 2 patients said that lack of information is also a reason for not attending general practices.

Theme 4: Non availability of doctors in out of hours is major issues you are facing to access General practice.

Interpretation- The above analysis conducted from the patients of NHS states patients are facing major issues in accessing general practices because of the non-availability of doctors in out-of-hours as said by 13 patients. On the other hand, the lack of telephonic system of booking is also one of the major issues that patients are facing as said by 3 respondents. Apart from this, 2 patients have lack of options of general practices in NHS and 2 said that high cost is also an another issue which they are facing to access General practices.

Theme 5: NHS needs to make the balance in the shift or working hours of doctors.

Interpretation  The above analysis conducted from the patients of NHS recommend that NHS should balance the shift or working hours of doctors as said by 8 respondents. 4 patients said that NHS should increase the workforce. On the other hand, 3 said that NHS should hire the new talents in the company and 4 said that they should improve the system of appointment.  

RECOMMENDATION

It is recommended that NHS should make some changes which are as follows-

• They should improve the technology like they use to book appointment of patients through online webs, telephones and other technologies (Andersen, Davidson and Baumeister, 2014).
• They should increase the workforce in NHS so that work stress or load will be divided.
• They should make a balance in the shift or working hours of doctors.
• They should manage the workload of doctors so that they give quality of services to patients.
• They should make arrangements of staff in out-of-hours.

REFERENCES

• Andersen, R.M., Davidson, P.L. and Baumeister, S.E., 2014. Improving access to care. Changing the US health care system: key issues in health services policy and management. San Francisco: Jossey-Bass, pp.33-69.
• Betancourt, J.R., Green, A.R., Carrillo, J.E. and Owusu Ananeh-Firempong, I.I., 2016. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.
• Bibbins-Domingo, K., 2016. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: US Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 164(12), pp.836-845.
• Burwell, S.M., 2015. Setting value-based payment goals—HHS efforts to improve US health care. N Engl J Med,372(10), pp.897-899.
• Coulter and et.al., 2014. Collecting data on patient experience is not enough: they must be used to improve care. BMJ (Clinical research ed.),348(mar26 1), pp.g2225-g2225.

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