Table 2 Factors identified in our study according to the Levesque et al. [33] supply- and demand-side determinants of access

Approachability (4 publications)

- The promotion of general practice services, including targeted preventive health assessments.

- GP awareness of targeted preventative health assessments.

- The need for clinical information systems that can identify people with intellectual disability, so it is easy to invite, recall and remind people to participate in general practice.

Ability to perceive (11 publications)

- Generally low health-literacy levels of people with intellectual disability, their family and support workers.

- Generally low educational levels, which reduces the ability to access health information for some people with intellectual disability.

- Need for targeted health promotion for people with intellectual disability.

Acceptability (28 publications)

- GP education and experience of treating people with intellectual disability.

- Perceived discrimination, insensitivity or negative attitudes from GPs in the health care of people with intellectual disability.

- Provision of reasonable adjustments to facilitate access to general practice, such as flexibility with appointment times or prescription collection.

Ability to seek (7 publications)

- Knowledge of available general practice services among people with intellectual disability, their family and support workers.

- Fear or anxiety around attending general practice or being examined.

- People’s confidence in interacting with general practice staff, managing their own health information and making supported independent health decisions.

Availability & accommodation (24 publications)

- The amount of consultation time needed to overcome communication barriers and manage the often-complex health status of people with intellectual disability.

- The numbers of GPs and other health professionals in rural locations.

- Length of waiting times to receive appointments, waiting-room times before appointments and ensuring physical accessibility.

Ability to reach (9 publications)

- Geographical isolation.

- Access to public transport when unable to drive.

- Challenges with booking appointments independently or organising support workers to assist with attendance.

- Alleviating the burden of frequent health- or disability-related appointments.

Affordability (8 publications)

- Providing adequate renumeration for GPs to have longer appointments, bulk bill or complete a preventive health assessment.

Ability to pay (9 publications)

- Levels of funding for people with intellectual disability and generally lower socio-economic status.

- Costs of travel to general practice and support workers attendance.

Appropriateness (30 publications)

- Patchy coordination of disability and health services by GPs.

- Provision of targeted preventative health assessments.

- Fragmented continuity of care (not accessing the same GP on every occasion).

- Diagnostic overshadowing with GPs assuming symptoms are a consequence of a person’s disability without exploring other factors such as biological determinants.

- Clinical inertia, where GPs fail to initiate or intensify therapy when evidence-based treatment goals are not achieved.

- of the need for evidence-based guidelines specifically for people with intellectual disability.

Ability to engage (30 publications)

- Communication challenges.

- Support worker facilitation and advocacy during consults.

- Patient capacity to make informed, independent health decisions.

- Patient and support staff unaware of complete medical history.