A scoping review of how the candidacy framework has been used in research on access to general practice

Objectives

Access to general practice is a pervasive health services concern. A tendency to conceptualise access narrowly in terms of supply of appointments may frustrate identification of better solutions. The Candidacy Framework offers an alternative conceptualisation of access as a dynamic and contingent process. We aimed to identify how the Candidacy Framework, and each of its seven features, has been applied and critiqued in research in general practice.

Methods

We conducted a scoping review involving a search across four databases to identify general practice articles, editorials, books, and theses that applied the Candidacy Framework. Included studies underwent data extraction and findings were analysed descriptively.

Results

Of 12,759 records screened, 73 studies published between 2007 and 2024 were included in the review. The Candidacy Framework was predominantly used in designing research or supporting interpretation of research findings. Sixty-seven papers explicitly used at least one of the seven features of candidacy; ‘navigation’ was the feature most mentioned and ‘operating conditions’ least. Candidacy appeared particularly helpful for: (1) exploring healthcare staff-patient interactions; (2) understanding barriers and enablers to accessing care; and (3) exploring complex access challenges faced by disadvantaged groups. Critiques of the framework focused on perceived linearity, lack of acknowledgement of the potential for multiple candidacies, and a need for more emphasis on contextual influences beyond local operating conditions.

Conclusion

The Candidacy Framework is a useful approach for understanding access to general practice and may help in generating actionable solutions but may be enhanced by further customisation for the specifics of this setting.