This project aligns with NHS priorities. The national 10-Year Health Plan aims to “end the 8am scramble” by training thousands more GPs and expanding online advice through the NHS App, ensuring that anyone who needs one can access a same-day GP appointment.

• Reducing health inequalities
• Improve patient access to general practice and improve patient experience
• Shift from analogue to digital: making full use of digital tools, AI and other technology
• Moving care from hospitals to communities: development of ‘neighbourhood health centres’
• Moving from treatment to prevention: focusing more on preventing ill health than on treatment, including wider determinants of health and factors that influence a person's need for care.

• To inform local and national strategies on how to improve primary care access and experience for patients
• To reduce inequalities in accessing primary care

The way we book an appointment with a GP is changing. Since 1st October 2025, patients can request non-urgent appointments online from 8 am to 6.30 pm, following national plans to “end the 8am scramble”.  Online access to GP appointments may improve efficiency and help manage demand, however, there are growing concerns that wider use of online access methods may deepen the digital divide. This is particularly relevant for groups already at risk of health inequality, such as older people, those from ethnically diverse backgrounds and those from low income households.

The importance of choice over how you request an appointment was reinforced in a new patient charter: You and Your General Practice, which states that a patient can request an appointment by completing an online form, calling the GP practice, or visiting in person. Yet many GP practices use ‘total digital triage’ systems where all requests are made through a single online consultation tool and triaged according to clinical need. When support is provided for people to complete an online form, these systems can enhance access and improve demand management, however, questions have been raised about how best to safely manage online access and ensure that no one is left out. This is what this project seeks for find out.

Online access may work well for some people and not for others. Yet few research projects have studied the impact of online appointment requests since the adoption of total triage from the perspective of people at risk of health exclusion. This research seeks to address this gap by identifying what helps and what hinders socially disadvantaged groups, older adults and ethnically diverse populations when trying to access GP services. We will study this from the perspective of people living in areas of high deprivation and by talking to GPs and practice staff. By working together with representatives from primary care, the community, and voluntary and charitable organisations, we will develop recommendations for improving equitable access to general practice.  

We have chosen to undertake this study in Luton, Bedfordshire, UK.

Luton is one of the most densely populated area outside of London, including areas of high deprivation and a high level of health inequality. It is an extremely ethnically diverse town, with more than half of its population being non-white British. This makes Luton an exemplar location for research to better understand the complex relationship between diversity, health inequality and access to healthcare.

The study is hosted by the University's Integrated Care Research Hub which is funded by the NHS England.

How can we improve access to general practice for minority ethnic communities and older people living in areas of high deprivation in Luton?

Study objectives

1. To identify the barriers and facilitators that shape access to general practice for minority ethnic communities and older people (aged 70+) living in deprived areas.
2. To explore the perspectives of other key stakeholders (e.g. representatives from the voluntary sector, GPs and practice staff) on access to general practice in areas of high deprivation.
3. Review data on GP appointments, patient satisfaction, and information provided on GP practice websites to compare with qualitative data.
4. To develop evidence-based, co-produced recommendations for improving equitable access to general practice in high-deprivation contexts

The study uses a mixed-method design; the emphasis is on qualitative exploration of views and experiences, supported and compared with analysis of local health data and a GP website audit.

Phase 1: We use a community engagement approached called ‘Talk, Listen, Change’ (TLC) developed at the University of Bedfordshire. With the help of local community researchers, and voluntary and community organisations, we will talk to up to 45 Luton residents living in areas of high deprivation, including people from different minority ethnic communities and older people. We will be focusing on South Asian communities, Black African and Caribbean communities, Eastern European, Roma, Gypsy and Traveller communities in Luton. This will enable us to compare barriers and enablers to GP access in different groups.

To gain a wider perspective on local issues, we will talk to 10 people who work with these communities, such as representatives from voluntary and community groups. To compliment this qualitative work, we will look at data on patient satisfaction and access to GP services in Luton and conduct a review of information provided on GP practice websites as to how to make a GP appointment.

Phase 2: In the second phase, we will engage with GPs and staff in general practices in Luton who have years of experience of providing GP services in areas of high deprivation. Through this we will capture what has worked well and what has not worked well in relation to enabling access to GP services for older people and ethnic minority communities in areas of high deprivation.

Phase 3: We will co-develop recommendations for improving equitable access to general practice in high-deprivation contexts.