“You’re only a receptionist, what do you want to know for?”: Street-level bureaucracy on the front line of general practice

Context or Objective: In care settings across the globe non-clinical staff are involved in filtering patients to the most appropriate source of care. In primary care in the UK, general practice receptionists are key in facilitating access to individual practice organisations, and the wider National Health Service. The complexity and significance of their role has yet to be explicitly recognised by policymakers and commissioners and little is known of how the decision-making behaviours of receptionists’ impacts policy implementation and service delivery.

Study Design and Analysis: For the first time we have used the agent-based implementation theory of street-level bureaucracy to understand the impact of individual receptionists on patient access to primary care in the UK. We analysed the data within a trilevel analytical model to incorporate broader contextual influences: The micro-level relates to influences on decision making acting at an individual level; the meso-level influences at group and organizational levels; and the macro–level influences at a societal or policy level.

Setting or Dataset or Population Studied: Semi-structured interviews conducted with 19 UK receptionists working in family practice in the UK.

Intervention/Instrument or Outcome Measures or Results: At the micro-level we determined how receptionists are influenced by the level of rapport developed with patients and would use common sense to interpret urgency. At the meso-level, influences included their position at the forefront of premises, the culture of the workplace, and the processes and protocols used by their practice. At the macro-level, participants described the impact of limited health service capacity, the lack of mandatory training, and the growth in the use of digital technologies: Conclusions: Receptionists, attempt to provide universality without sufficient resource, This theoretical framework also benefits from being an accessible foundation on which to base practice and policy changes.