In the last issue of this journal, our editor, Richard Draper, highlighted the worldwide shortage of primary care physicians. This shortage has been well documented in the UK and is keenly felt by patients, GP trainers and their trainees up and down the country. Access to care has become not only the subject of a multitude of headlines, but the battle ground for annual contract negotiations. The range of clinicians working in primary care settings has become more diverse, in large part to meet this challenge. Practices have merged and expanded, with bigger list sizes and more complex telephone and triage systems. Whether or not a GP was accessible often grabs headlines too. Demoralising as this may be, remember that even under the weight of enormous lists of patients to be seen, for primary care to be useful, patients need access reliably. This might be at odds with the pervading emotions experienced on a daily basis by GPs and their teams as they try to meet the growth in demand for appointments. GP trainees finding themselves in this environment for the first time may feel understandably daunted. Your first experience of access as an issue may be with a patient who grumbles (or even complains) about how difficult it was to get to see you. Even in the maelstrom of appointments, it can be helpful in those early consultations to reflect specifically on how access affects consultations. Thinking about, reflecting and even studying how marginalised groups can gain access to appointments may make consultations more effective and perhaps form the basis for some quality improvement projects.
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