Appointments aren’t Access: The Hidden Work of Getting Care

Primary care access is often judged by appointment supply, waiting times, and utilisation, yet patients experience access as a series of small obstacles that accumulate into delay, drop-off, and avoidable deterioration. Building on existing literature on administrative burden, treatment burden, digital exclusion, and telemedicine inequity, this commentary proposes the Access Friction Index (AFI) as a practical framework for measuring the real-world effort required to convert a health need into timely assessment, follow-up, and treatment. Drawing on recent evidence from the UK, US and other settings, it links access friction to inequities for vulnerable groups, missed screening, medication non-adherence, unplanned return visits, and avoidable hospital use. It also outlines how routine service data and electronic records could be used to identify friction hotspots—including repeated contact, mode switching, handoffs, results handling failures, and delayed pathway closure—and how primary care-community approaches such as navigation and outreach might reduce friction while improving outcomes.

Read more in our article in the Journal of Primary Care & Community Health.

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