How do GP staff attitudes and behaviours impact on access amongst disadvantaged groups?


The NSMC commissioned M·E·L Research to conduct qualitative insight generation across England
and Wales to explore the impact of GP surgery staff attitudes and behaviour on presentation at Primary
Care amongst disadvantaged groups. The study was designed to inform social marketing interventions
to tackle health inequalities and increase earlier presentation to Primary Care amongst disadvantaged
groups of the population.

The study gathered the views of participants from particular age and socio-economic groups who do not
present, or present late, at Primary Care including those diagnosed with, or at risk of, specified chronic
conditions associated with health inequalities. We used the Department of Health’s Healthy
Foundations segmentation to recruit participants from the ‘Disengaged’ and ’Survivors’ segments.


Using QoF data (Quality and Outcomes Framework) on health inequalities and ACORN GIS software to inform four fieldwork sites in England and four in Wales, we conducted 8 focus groups with 56 participants, 20 in-depth interviews, 8 ‘customer journey mapping’ interviews and 7 paired interviews. GP surgery staff in focus included GPs predominantly but also nurses as well as non-clinical staff (receptionists). Having analysed these findings, we carried out 13 semi-structured interviews with surgery GPs, nurses and receptionists during which we discussed the emerging findings and generated further insight from a staff perspective.


The insight generated was used to inform The NSMC’s health inequalities programme, with a particular focus on how staff attitudes and behaviours can be shaped to increase access to Primary Care for those from disadvantaged groups.

The research identified a range of factors related to the attitudes and behaviour of both clinical staff predominantly GPs) and non-clinical staff which were highlighted as ‘good practice’, make for a positive patient experience and encourage presentation at Primary Care, as well as ‘bad practice’ examples
which can deter presentation amongst disadvantaged groups. The research also identified a range of systemic factors (e.g. the appointment system) and internal factors (e.g. fear) which can deter Primary Care presentation.