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Background The North American model of 'advanced access' (AA) has been emulated by the National Primary Care Collaborative in England as a way of improving access in primary care. Aim To elucidate the procedures for implementing AA in general practice. Design Qualitative study. Method Semi-structured interviews were conducted with 18 general practice staff from six practices: six GPs, six practice managers and six receptionists. Two neighbouring boroughs in south-east England were used as the study sites. NUD*IST computer software assisted in data management to identify concepts, categories and themes of the data. Data were analysed according to the five themes emerging from the transcripts. Results The main issues involved in preparing for the transition include definition of the nature of the new appointments system and monitoring of the new system to ensure flexibility within it. The critical topics for management in dealing with staff were to ensure inclusivity when informing them about advanced access, offering informal opportunities for raising concerns or opinions and effective management for addressing staff anxiety. The primary care trusts' support was limited to ensuring that the government targets were met. Conclusions This study offers insights into the ways in which six general practices in south-east England successfully implemented AA to assist others planning to undertake such a change. It also suggests pitfalls encountered by practices in implementing AA. It highlights that the greatest resistance to implementing AA arises from clinicians. Though proponents of AA would suggest that it requires few resources to implement, this study suggests otherwise. There is also a need for more research to evaluate the cost-effectiveness of the approach of the Primary Care Collaborative as a change agent.