{
  "abstract": "ObjectivesTo examine whether increased appointment volumes were associated with shorter waiting times or lower patient dissatisfaction, and whether shorter waiting times were associated with lower patient dissatisfaction, in National Health Service (NHS) primary care in England.\n\nDesignRetrospective observational study using the Appointments in General Practice dataset and the General Practice Patient Survey (GPPS). Changes were compared across Integrated Care Boards (ICBs) over 2018-2022 and 2022-2023, stratified by staff group and appointment mode, alongside annual panel fixed-effects models.\n\nSettingNHS primary care in England, 2018-2024.\n\nParticipantsAll 42 ICBs in England (294 ICB-year observations).\n\nPrimary Outcome MeasuresMean waiting time between booking and appointment, and patient dissatisfaction: the share of GPPS respondents rating their overall experience of their GP practice as \"neither good nor poor\", \"fairly poor\" or \"very poor\".\n\nResultsCompleted appointments rose over 2018-2024, with care shifting towards non-GP staff and virtual delivery. Per million additional appointments, waiting time changed by -0.04 days (95% CI -0.10 to 0.03) in 2018-2022 and -0.31 days (-0.57 to -0.04) in 2022-2023, and dissatisfaction by 0.02 percentage points (-0.36 to 0.40) and -0.75 percentage points (-3.05 to 1.56). Per additional day of waiting, dissatisfaction changed by -1.40 percentage points (-3.21 to 0.42) in 2018-2022 and 2.85 percentage points (1.20 to 4.51) in 2022-2023, when changes in appointment volume were small. In fixed-effects models over 2018-2024, all three associations had 95% CIs including zero.\n\nConclusionsGrowth in appointment volume did not translate into consistent improvement in waiting times or patient dissatisfaction, and shorter waiting times were not consistently associated with lower dissatisfaction. Either these quality metrics do not respond to output, the key factor under providers control, or they do not capture the dimensions of quality that matter. Performance frameworks that assess primary care productivity through these metrics should be reviewed.\n\nStrengths and Limitations of this StudyO_LIThe analysis covers all 42 ICBs in England from 2018 to 2024 (294 ICB-year observations), so it includes the full population rather than a sample. C_LIO_LICross-ICB comparisons over two periods were complemented by panel fixed-effects models with ICB and year fixed effects, with standard errors clustered at the ICB level. C_LIO_LIPatient dissatisfaction was constructed from harmonised, weighted GPPS response counts, using a question and definition that are consistent across all survey years. C_LIO_LIThe analysis is observational and conducted at the ICB level, so associations are not causal and within-area variation across practices and patient groups is not captured. C_LIO_LIWaiting times were derived from administrative categories rather than exact waits, and the analysis includes no direct measures of patient health. C_LI",
  "abstract_shown": true,
  "affiliations": [
    "Ellison Institute of Technology"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "R. Joseph"
    },
    {
      "name": "H. Gupta"
    },
    {
      "name": "S. Danielli"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ewdv1tx2j7vj9.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.07.29.26359221",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.07.29.26359221v2.full",
  "id": "ewdv1tx2j7vj9",
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  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.07.29.26359221v2",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "health systems and quality improvement"
    ],
    [
      "openalex",
      "3600|Primary Care and Health Outcomes"
    ]
  ],
  "openalex": "W7171920010",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.07.29.26359221v2.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-07-29",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/ewdv1tx2j7vj9.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:51Z",
      "native_id": "10.64898/2026.07.29.26359221",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.07.29.26359221v2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:health systems and quality improvement",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Do More Appointments Lead to Shorter Waits and Better Patient Experience? A Retrospective Observational Study of NHS Primary Care",
  "title_text": "Do More Appointments Lead to Shorter Waits and Better Patient Experience? A Retrospective Observational Study of NHS Primary Care",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:51Z",
  "url": "https://research.draconitic.com/paper/ewdv1tx2j7vj9",
  "venue": "medRxiv",
  "versions": []
}