TY - JOUR T1 - Access to primary care: creative solutions are needed JF - British Journal of General Practice JO - Br J Gen Pract SP - 620 LP - 621 DO - 10.3399/bjgp15X687697 VL - 65 IS - 641 AU - Roger Jones Y1 - 2015/12/01 UR - http://bjgp.org/content/65/641/620.abstract N2 - In her landmark Lancet article ‘Is primary care essential?’1 Barbara Starfield described primary health care as being first-contact care that is comprehensive, coordinated, and continuous. To this could be added something about accessibility and effectiveness and, in the UK context at least, care that is provided locally and personally. In these changing times, most of these attributes of good primary care have come under pressure. Comprehensiveness can be threatened by inequalities in access, fragmentation of primary care teams, discrimination, and the effects of the inverse care law.2 Continuity is increasingly difficult to deliver, for well-rehearsed reasons, and coordination is often more of an aspiration than an achievement because of dysfunctional communication across the primary–secondary care interface. Finally, access, a crucial dimension of primary care, has become a political and professional battlefield in recent years. In last month’s issue of the BJGP Simpson and colleagues3 called for a policy rethink on access, and for a more nuanced debate to take us beyond the simple metrics of waiting times and capacity. This month, Access to Care is the major theme of the journal, with articles on the research evidence related to access,4 the controversy about 7-day NHS opening,5 and the persistent, pernicious influences of deprivation on equity and equality.6The need for a more sophisticated discussion of access is emphasised by Campbell and Salisbury’s Research Into Practice article,4 in which they review the evidence on new opportunities to measure and improve access, as well as providing a useful model of the various factors and forces at play. Their careful review serves to show that the evidence base for much organisational thinking and policy rhetoric is based on very thin evidence or no evidence at all, although it is clear that good ideas may work well … ER -