Bugbears in the Waiting Room: Revisiting Arber and Sawyer's Classic Study of GP Reception Work Using Ethnography in Eight English General Practices

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.