Objective: Genitourinary service providers are struggling to meet patient demand and have introduced changes in access structure to cope. In this study, we explored the perspectives of clients and providers upon the different models of access introduced and whether these maintained service quality using the SERQUAL model.
Methods: Primary data were collected in May 2005 at two genitourinary medicine clinics, two Accident and Emergency Departments and from members of a university 'gay' society all of which were located in London. Forty-four high-risk clients and 11 health service providers underwent semi-structured face-to-face interviews.
Results: Both the walk-in and appointment-based access systems were appreciated by clients. Clients said that the most important issue was that they were not turned away when they presented. Health-care providers had a variety of opinions about the two systems as they had different impacts on morale, training and service provision.
Conclusions: Service quality can be maintained by using both walk-in and appointment-based systems. This is because our data, in line with Parasuraman's model of service quality, showed that 'access' is but one determinant of quality. Having different modes of access facilitates patient choice, which is paramount in a modern health-care system. However, to provide a good service it is important to maintain a motivated staff, who can be affected by their working environment.