Anna Dowrick

Context: Rising demand for GP services alongside limited change in supply is placing unprecedented pressure on primary healthcare systems in many countries, including the UK and Denmark. The 2026 English GP contract requires practices to provide same day access to all patients considered to have an urgent need. Objectives: To study primary care staff reflections on their experiences of prioritising same day access through different approaches, which their practices had chosen and adapted over months and years. Design: A subset of three case studies (two in England, one in Denmark) from a larger focussed ethnography. These practices were selected for the sub‐study because they all prioritised same day access but had developed different approaches. We draw on formal and informal interviews with staff and observations in the practices. Results: The different rationales for introducing same day access in these three practices had been to reduce long waiting times, to tackle non‐attendance at pre‐booked appointments and to help address limited GP capacity. Systems were maintained by weekly and daily tinkering with appointment capacity, by managing the balance of access and continuity, understanding where exceptions were important for different patient groups and, in the English case studies but not in Denmark, by channelling patients to allied health care professionals. In all cases, consideration was given to the trade‐off for patients between urgency and continuity. Staff drew on their own experiences to caution against entirely open appointment booking systems. Staff in all three sub‐study practices had, based on their experiences, started to think differently about how best to manage same day access. Our findings, comparing the English and Danish practices, raise the counter‐intuitive possibility that, rather than opening the floodgates, making it easier for patients to access GP appointments when needed might help moderate total demand. Conclusions: These findings matter in relation to the 2026 GP contract, which has specified that 90% of appointments deemed ‘urgent’ by the practice must be seen on the same day. When dealing with seemingly overwhelming demand, it is tempting to introduce channels and diversions to protect supply, or even to question whether the demand is justified. Our findings suggest a pertinent metaphor: it is now recognised in flood prevention that the introduction of man‐made channels has exacerbated the problem of flash flooding, while the use of open, naturally managed flood plains is beneficial. This metaphor may help practices to understand the consequences of their response to the new requirement for same day access. Patient and Public Contribution: The wider ethnographic study was guided from inception to completion by a PPI co‐applicant and eight PPI representatives who, between them, represented a diversity of lived experience. In relation to this article, the PPI co‐applicant reviewed practice summaries and provided sense‐checking of our ideas and interpretations.

Background: New drugs and vaccines usually come with the promise and hope of benefit. We explore stories about the variable and sometimes disappointing effects of Covid‐19 vaccines in the context of post‐Covid‐19 syndrome (‘long Covid’), aiming to understand how people with long Covid made sense of unexpected vaccine responses and how these experiences impacted their trust in vaccination. Methods: We carried out 33 interviews with people who described both positive and negative unexpected vaccine experiences connected to long Covid. Results: Trust and distrust in the multiple potential roles of Covid vaccines in relation to long Covid impacted perspectives on future vaccine uptake. Some participants feared being labelled as anti‐vaxx if they discussed unexpected vaccine impacts. Disengagement by healthcare professionals in discussions about the possibility of individual vaccine harms had the inverse consequence of limiting uptake of further Covid vaccines. Distrust could also grow in relation to unrealised benefits of vaccination—in this case, the official role as protection from severe infection and the unofficial role of treatment. Participants who trusted vaccines as a form of treatment struggled to access them for this use. Conclusion: The gap between scientific discourse—which recognised potential benefits and potential harms of vaccines in relation to long Covid—and public health discourse, which tended to focus on protection from infection, contributed to difficulties in maintaining trust after unexpected vaccine experiences. Further research to better characterise who is likely to benefit from vaccination and who might be at risk of worsening long Covid symptoms would enable better conversations between patients and healthcare professionals when making decisions about further vaccination. Patient or Public Contribution: The study was guided by a patient and public involvement and engagement (PPIE) group from project development through to dissemination. People with long Covid supported recruitment strategies, informed the development of topic guides, reviewed findings and offered suggestions for dissemination. Study participants were also invited to review and feedback on findings.

There is an ongoing debate around how to design online synchronous qualitative research studies, and respond in the moment, when researchers suspect that they are engaging with ‘impostor’ or ‘fraudulent’ participants. Initial literature framed ineligible participants as a threat to data quality and the integrity of the research itself, calling for reactionary approaches to potential participants. This paper contributes to the growing literature cautioning that strict screening approaches may negatively harm genuine participants and undermine inclusion efforts. This paper explores the concept of ‘knowing’ research participants in qualitative research, focusing on methods that enhance how we genuinely come to know the participants we seek to include, particularly in reclaiming interactions that may have become curtailed during online research. Through consideration of researchers’ ethical responsibilities in relation to what is presumed or learned, we offer methodological reflections on how researchers’ skilful attention to the research encounter may be all that is required to ensure continued research integrity within the context of inauthentic participants. Taking actions to better know participants upholds our ethical responsibilities to them and also has the effect of identifying inauthentic participants who intentionally falsify their accounts.

We revisit a time in 2021 when people in the UK were coming to terms with an unwanted future characterized by chronic COVID-19 infection. Drawing on experiences of people who had already experienced COVID-19 infection, we explore how they made sense of newly perceived vulnerabilities and the possibility of reinfection. We highlight the work of speculating about the future, which involved making "educated guesses" based on embodied knowledge as understanding about different consequences of "living with COVID-19" moved in and out of view.

Governments across the world differently invoked citizen responsibility for responding to the risk of COVID-19 infection. Approaches which focused on changing social practices served to reinforce distinctions between 'sanitary' and 'unsanitary' citizenship. This paper examines citizens' responses to public health policy messaging, exploring as a case study the reception of UK Government messaging about responsible behaviour during the first two years of the COVID-19 pandemic. We examine the public responses to such messaging from narrative interviews with 43 people who became ill with COVID-19. These interviews were with people who identified as members of the minoritised religious and racialised groups, who were most heavily burdened by the impact of COVID-19. Interviewees challenged assumptions that they were 'irresponsible' for having caught COVID-19, and instead directed attention towards the ways in which pandemic guidance was unworkable. Some actively critiqued government messaging, questioning the problematic racialisation of pandemic messaging and challenging individual responsibilisation for the management of the pandemic. Through this analysis we demonstrate the active role of citizens in enacting, and at times resisting, health policy.

Background: Identifying and responding to patients affected by domestic violence and abuse (DVA) is vital in primary care. There may have been a rise in the reporting of DVA cases during the COVID-19 pandemic and associated lockdown measures. Concurrently general practice adopted remote working that extended to training and education. IRIS (Identification and Referral to Improve Safety) is an example of an evidence-based UK healthcare training support and referral programme, focusing on DVA. IRIS transitioned to remote delivery during the pandemic. Aim: To understand the adaptations and impact of remote DVA training in IRIS-trained general practices by exploring perspectives of those delivering and receiving training. Design and setting: Qualitative interviews and observation of remote training of general practice teams in England were undertaken. Method: Semi-structured interviews were conducted with 21 participants (three practice managers, three reception and administrative staff, eight general practice clinicians, and seven specialist DVA staff), alongside observation of eight remote training sessions. Analysis was conducted using a framework approach. Results: Remote DVA training in UK general practice widened access to learners. However, it may have reduced learner engagement compared with face-to-face training and may challenge safeguarding of remote learners who are domestic abuse survivors. DVA training is integral to the partnership between general practice and specialist DVA services, and reduced engagement risks weakening this partnership. Conclusion: The authors recommend a hybrid DVA training model for general practice, including remote information delivery alongside a structured face-to-face element. This has broader relevance for other specialist services providing training and education in primary care.