Bugbears in the Waiting Room

Revisiting Arber and Sawyer's Classic Study of GP Reception Work Using Ethnography in Eight English General Practices

Bibliographic Data

ID5659561
AuthorsCatherine Pope (0000-0002-8935-6702, Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK, corresponding author), A Driessen (0000-0001-5627-1684, Department of Anthropology University of Amsterdam Amsterdam the Netherlands), Audrey Eccles (0000-0002-9792-8299, Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK), Bella Wheeler (0000-0001-8721-5669, Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK), Carol Bryce (0000-0003-1484-9032, Unit of Academic Primary Care Warwick Medical School Coventry UK), Jennifer Heath (0000-0001-6249-3662, Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK), C S G Phillips (0009-0001-5586-6595, Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK), Toto Gronlund (0000-0001-8237-322X, Public Representative. C/O Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK), Helen Atherton (0000-0002-7072-1925, School of Primary Care Population Health and Medical Education University of Southampton Southampton UK)
Year2025
Volume47
Issue8
Pagese70104-e70104
Publication date2025-11-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSociology of Health & Illness (JOURNAL)
Journal identifiersISSN: 0141-9889 • E-ISSN: 1467-9566
PublisherWiley (PUBLISHER • GB)
DOI10.1111/1467-9566.70104
PMID41081446
OpenAlexW4415131021
LanguageEN
Citations received2
References cited46

In 1985, Arber and Sawyer described the discretionary rationing power of general practice receptionists. Our paper revisits this territory. Much has changed in the intervening decades. Digitalisation has altered reception work. Increasing multimorbidity and rising chronic illness, combined with a dwindling workforce, restricted funding and systemic pressures on public services, have fuelled the 'crisis' in general practice. 'Unacceptable' delays in getting a general practitioner (GP) appointment are seen as evidence of this. Our focused ethnography in eight English NHS general practices highlights important shifts in receptionists' management of GP access. We observed waiting and reception areas, interviewed 70 staff and 74 patients and examined practice documents. Arber and Sawyer's dragon metaphor remains salient, but receptionists have new strategies of bureaucratic distancing and redirection to manage appointment requests. They are gatekeepers still and remain a target for hostility but mitigate this by using these strategies. Patients on a quest to obtain an appointment with a GP may still be thwarted and sometimes meet dragons at the desk, but they may more often find themselves allied with the receptionist. The barrier to getting a GP appointment has become the access system and its discorporate digital forms, rather than the receptionist or the GPs she protects

Healthcare Quality and Management · Healthcare Systems and Technology · Primary Care and Health Outcomes

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