Impact of initiatives to improve access to, and choice of, primary and urgent care in England: A systematic review

- Review of evidence on initiatives to improve access to primary/urgent care in England.
- We examine impact on demand, equity, patient satisfaction, referrals, and costs.
- Ten new initiatives generated complex system of overlapping services.
- New provision did not induce substitution and likely increased overall demand.
- Existing services likely to improve access at lower marginal costs than new ones.

BackgroundThere were ten initiatives in the primary and urgent care system in the English NHS during the New Labour government, 1997-2010, aimed at delivering higher quality, more accessible and responsive care by expanding access, increasing convenience and introducing greater patient choice of provider. We examine their impact on demand, equity, patient satisfaction, referrals, and costs.MethodsStudies were systematically identified through electronic databases and reference lists of publications. Studies of all designs were included if published between 1997 and 2013, and with empirical data on the impacts above.ResultsNineteen studies of ten initiatives were included. Innovations often overlapped, complicating care. There was some demand for new provision on grounds of convenience, but little evidence of substitution between services. Patient satisfaction varied across schemes. There was little evidence on the costs and benefits of new versus existing provision.ConclusionNew services generated a more complex system where new and existing providers delivered overlapping services. The new provision did not induce substitution and was likely to have increased overall demand. Initiatives to improve access to existing provision may have greater potential to improve access and convenience at lower marginal costs than developing new forms of provision.