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We lead multidisciplinary applied research and training to rethink the way health care is delivered in general practice and across the community.
Experiential caring and the mobilisation of peerhood in group clinics
The concept of ‘peer support’ has generated much interest in mainstream health services. In policy discourse, peer-based initiatives are often described as ‘empowering’ and seen as contributing to more ‘democratic’ and ‘holistic’ forms of care. Focusing on group clinics as one such example, this article challenges the assumption that peer-based initiatives represent a straightforward and unequivocal ‘good’ when embedded in clinical care. We draw on qualitative data from three studies (2016–2025), including 118 interviews and ethnographic observation in 59 in-person, remote, and hybrid group clinics for diabetes and menopause at 5 primary and secondary care sites in England. Adopting a sociomaterial lens, we uncover how different forms and practices of peerhood emerge (or not) in the circumstances through which these clinics are materialised. We show how biomedical artefacts (e.g. diabetes test results, menopause symptom lists) used as part of consulting play a key role in constituting forms of affiliation and differentiation between patients, in turn determining whether and what forms of peer ‘support’ (e.g. disciplinary, affirmative) are accomplished. We go on to explore how being presented as a peer as part of clinical consulting brings about new roles and responsibilities for patients, and introduce the term ‘experiential caring’ to denote a new mode of consulting that mobilises roles, practices, and subjectivities associated with peerhood.
Evaluating video and hybrid group consultations in general practice: mixed-methods, participatory study protocol (TOGETHER 2)
Background: General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these challenges, some practices in the UK have been delivering video and hybrid group consultations (VHGCs) providing clinical care to multiple patients at the same time. Despite positive initial findings and enthusiasm, there are still gaps in our understanding of the influence VHGCs have on patient experience, healthcare utilisation, quality, safety, equity and affordability. Objectives: To generate an in-depth understanding of VHGCs for chronic conditions in general practice, surface assumptions and sociotechnical dynamics, inform practice and extend theorisation. Methods: Mixed-methods, multi-site research study using co-design and participatory methods, from qualitative, quantitative and cost-related perspectives. WP1 includes a national, cross-sectional survey on VHGC provision across the UK. In WP2 we will engage patients and general practice staff in co-design workshops to develop VHGC models with emphasis on digital inclusion and equity. In WP3 we will carry out a mixed-methods process evaluation in up to 10 GP practices across England (5 sites already running VHGCs and 5 comparison sites). Qualitative methods will include interviews, focus groups and ethnographic observation to examine the experiences of patients, carers, clinical and non-clinical NHS staff, commissioners and policy-makers. Quantitative methods will examine the impact of VHGCs on healthcare utilisation in primary and secondary care, patient satisfaction, engagement and activation. We will also assess value for money of group and individual care models from a health economics perspective. Conclusions: We aim to develop transferable learning on sociotechnical change in healthcare delivery, using VHGCs as an exemplar of technology-supported innovation. Findings will also inform the design of a future study.
Guidance on the introduction and use of video consultations during COVID-19: Important lessons from qualitative research
Background Following several years of qualitative research, we have developed evidence-based guidance on setting up and conducting remote video consultations. Drawing on emerging evidence, we have also adapted the guidance to ensure accessibility and relevance for those using video calling during and beyond the COVID-19 pandemic. Findings This article describes the research underpinning this guidance material, with a focus on three key areas: (1) IT infrastructure, (2) organisational routines and workflows, and (3) interactional work of a video consultation. Our research highlights that such change is not merely about installing and using new technology. It involves introducing and sustaining major changes to a complex system with multiple interacting components. Conclusion If remote video consultations are to be adopted at scale, implementation will need to follow a socio-technical approach, continually adjusting the technology and work processes to become better aligned.
Evaluating video and hybrid group consultations in general practice: mixed-methods, participatory study protocol (TOGETHER 2)
Background: General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these challenges, some practices in the UK have been delivering video and hybrid group consultations (VHGCs). Despite positive initial findings and enthusiasm, there are still gaps in our understanding of the influence VHGCs have on patient experience, healthcare utilisation, quality, safety, equity and affordability. Objectives To generate an in-depth understanding of VHGCs for chronic conditions in general practice, surface assumptions and sociotechnical dynamics, inform practice and extend theorisation. Methods Mixed-methods, multi-site research study using co-design and participatory methods, from qualitative, quantitative and cost-related perspectives. WP1 includes a national, cross-sectional survey on VHGC provision across the UK. In WP2 we will engage patients and general practice staff in co-design workshops to develop VHGC models with emphasis on digital inclusion and equity. In WP3 we will carry out a mixed-methods process evaluation in up to 10 GP practices across England (5 sites already running VHGCs and 5 comparison sites). Qualitative methods will include interviews, focus groups and ethnographic observation to examine the experiences of patients, carers, clinical and non-clinical NHS staff, commissioners and policy-makers. Quantitative methods will examine the impact of VHGCs on healthcare utilisation in primary and secondary care, patient satisfaction, engagement and activation. We will also assess value for money of group and individual care models from a health economics perspective. Conclusions We aim to develop transferable learning on sociotechnical change in healthcare delivery, using VHGCs as an exemplar of technology-supported innovation. Findings will also inform the design of a future study.
Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings
Background: Young people with diabetes experience poor clinical and psychosocial outcomes, and consider the health service ill-equipped in meeting their needs. Improvements, including alternative consulting approaches, are required to improve care quality and patient engagement. We examined how group-based, outpatient diabetes consultations might be delivered to support young people (16–25 years old) in socio-economically deprived, ethnically diverse settings. Methods: This multi-method, comparative study recruited a total of 135 young people with diabetes across two implementation and two comparison sites (2017–2019). Informed by a ‘researcher-in-residence’ approach and complexity theory, we used a combination of methods: (a) 31 qualitative interviews with young people and staff and ethnographic observation in group and individual clinics, (b) quantitative analysis of sociodemographic, clinical, service use, and patient enablement data, and (c) micro-costing analysis. Results: Implementation sites delivered 29 group consultations in total. Overall mean attendance per session was low, but a core group of young people attended repeatedly. They reported feeling better understood and supported, gaining new learning from peers and clinicians, and being better prepared to normalise diabetes self-care. Yet, there were also instances where peer comparison proved difficult to manage. Group consultations challenged deeply embedded ways of thinking about care provision and required staff to work flexibly to achieve local tailoring, sustain continuity, and safely manage complex interdependencies with other care processes. Set-up and delivery were time-consuming and required in-depth clinical and relational knowledge of patients. Facilitation by an experienced youth worker was instrumental. There was indication that economic value could derive from preventing at least one unscheduled consultation annually. Conclusions: Group consulting can provide added value when tailored to meet local needs rather than following standardised approaches. This study illustrates the importance of adaptive capability and self-organisation when integrating new models of care, with young people as active partners in shaping service provision. Trial registration: ISRCTN reference 27989430.
Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics
Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work and new roles and workflows), economically (costs and benefits are unevenly distributed across the system), technically (excellent care needs dependable links and high-quality audio and images), relationally (interpersonal interactions are altered), and clinically (patients are unique, some examinations require contact, and clinicians have deeply-held habits, dispositions and norms). Many of these challenges have an under-examined ethical dimension. In this paper, we present a novel framework, Planning and Evaluating Remote Consultation Services (PERCS), built from a literature review and ongoing research. PERCS has 7 domains—the reason for consulting, the patient, the clinical relationship, the home and family, technologies, staff, the healthcare organization, and the wider system—and considers how these domains interact and evolve over time as a complex system. It focuses attention on the organization's digital maturity and digital inclusion efforts. We have found that both during and beyond the pandemic, policymakers envisaged an efficient, safe and accessible remote consultation service delivered through state-of-the art digital technologies and implemented via rational allocation criteria and quality standards. In contrast, our empirical data reveal that strategic decisions about establishing remote consultation services, allocation decisions for appointment type (phone, video, e-, face-to-face), and clinical decisions when consulting remotely are fraught with contradictions and tensions—for example, between demand management and patient choice—leading to both large- and small-scale ethical dilemmas for managers, support staff, and clinicians. These dilemmas cannot be resolved by standard operating procedures or algorithms. Rather, they must be managed by attending to here-and-now practicalities and emergent narratives, drawing on guiding principles applied with contextual judgement. We complement the PERCS framework with a set of principles for informing its application in practice, including education of professionals and patients.
Digitally Enabled Care in Diverse Environments (DECIDE): protocol for a programme of rapid evaluation of technology-enabled remote monitoring in health and social care
Background: There is considerable interest in technology-enabled remote monitoring in the UK. The aim is to respond to system pressures and improve access, experience and quality of care. There is an urgent need for process, outcome and impact evaluations of interventions at various stages of development and implementation to address evidence gaps around adoption, spread, sustainability and inequalities. Aim DECIDE (Digitally Enabled Care in Diverse Environments) is a centre for rapid evaluation of technology-enabled remote monitoring funded by the National Institute for Health and Care Research (2023 to 2026). It aims to support service users, service commissioners and providers of remote monitoring services, to enable high quality care. Example questions include: Is the technology-enabled remote monitoring innovation needed and, if so, for whom? How are technology-enabled care pathways implemented, and what are associated outcomes and impacts? What are the opportunities and challenges for sustainability, scale-up and spread? Methods A range of qualitative, quantitative and economic methods will be used. Exact methods and questions will be dependent on the focus, scope and scale of each evaluation. Evaluations will be informed by relevant theory, including the Non-Adoption, Abandonment and the challenges to Spread, Scale-up and Sustainability of technological innovation in health and care (NASSS) framework. A User Advisory Group and External Steering Committee, both with diverse voices, will help shape evaluation design, implementation and dissemination. Project-led dissemination will ensure timely sharing of insights and support impact. Conclusion Evaluations will advance understanding of when and for whom technology-enabled remote monitoring innovation is needed; how it works and how factors related to the intervention, implementation process and wider context influence adoption; associated outcomes and impacts, whether and how these tackle inequalities; and potential challenges to scale and spread. We aim to inform decision-making by policymakers, commissioners, providers, patients/service users and researchers.
Conversations about FGM in primary care: A realist review on how, why and under what circumstances FGM is discussed in general practice consultations
Objectives Little is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients. Setting Primary care in England. Data sources Realist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients. Primary outcome measure This realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated. Results 124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations. Conclusions There is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities' health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation. PROSPERO registration number CRD42018091996.
Preventing type 2 diabetes: a qualitative study exploring the complexity of health-related practices in people with prediabetes
BACKGROUND: Despite the introduction of primary care-based diabetes prevention strategies, labelling people with prediabetes and encouraging behaviour change, type 2 diabetes continues to rise, causing significant morbidity and mortality. AIM: To examine how a prediabetes diagnosis influences a person's health-related practices. DESIGN AND SETTING: An in-depth qualitative study with 25 people with prediabetes, recruited via general practices. METHOD: The study included narrative interviews, patient-collected data, and follow-up interviews. Theoretical analysis was informed by Bourdieu's theory of practice. RESULTS: Participants with prediabetes, especially those from low-income and diverse ethnic groups, often had difficulty following prescribed 'lifestyle' recommendations. An individual's habitus - that is, their embodied traits and behaviour patterns that had built up over their life-interacted with life-world influences, including the expectations and health beliefs of people in their immediate social circle (such as partner, children, and work colleagues); norms associated with wider social rituals (such as birthday parties); and structural intersectional influences (especially food availability and cost, influences of advertising, access to green spaces, and precarity, for example, housing insecurity). Going against social norms and expectations may risk an individual's social positioning, cultural belonging, and sometimes job security. This risk was often experienced as more salient and pressing than a hypothetical future risk of diabetes. CONCLUSION: To improve the success of diabetes prevention efforts, interventions should go beyond individual-level behavioural advice to incorporate changes to the physical, economic, social, and cultural worlds that influence behavioural practices. By going against social norms 'healthy' behaviours may represent a personal social risk for some, particularly those from diverse ethnic groups.
PHOENIX: A new framework for applying psychological theories to the adoption of innovations by healthcare professionals
Abstract Background: Although implementation science has borrowed concepts from psychology to explain how individuals think and act in relation to innovation adoption, the use of psychology has been limited and not well adapted to the aims and obligations of professionals. We aimed to enrich implementation science with a broader set of psychological theories relevant for professional behaviour, drawing particularly on the diffusion of innovations and stages of change models.Methods : The study had two parallel components. The first was a hermeneutic review of how psychological theory has and could be used to understand innovation adoption by health professionals. The second component was an empirical case study of the implementation of guidance on routine HIV screening in three sites across two London hospitals. Primary data sources were synthesised and combined with emerging secondary research findings, each feeding into the other. Analysis focused empirically on how the stages of the diffusion of innovations adoption model (prior conditions, knowledge, persuasion, decision, implementation, confirmation) could be enriched by psychological theories. Results: The hermeneutic review identified at least 20 relevant psychological theories from social, organisational, developmental and sports psychology; many of these were not single theories but contributions from domains of evolving research, making this an underestimate of potentially relevant theory. We developed a model (PHOENIX) to encapsulate how psychological theory can help illuminate each stage of adoption from diffusion of innovations theory:· Person and History (prior conditions stage) – individuals’ characteristics and past experiences;· Overload avoidance (knowledge stage) – filtering strategies when faced with overwhelming amounts of new knowledge;· Evolving attitudes (persuasion stage) – a social process of collectively emerging views within a team;· Networked decisions (decision stage) – decisions at two levels of the department combined with individual judgements;· Implementation support (implementation stage) to turn an intention to act into actual action, with external supports valuable to reduce the cognitive effort required;· uneXceptional (confirmation stage) – sustained effort to turn the new behaviour from a conscious innovation to a habit. Conclusions: The PHOENIX model, if affirmed in further studies, has potential to enrich the study of innovation adoption by healthcare staff in organisational and professional contexts.
PHOENIX: A new framework for applying psychological theories to the adoption of innovations by healthcare professionals
Abstract Background Although implementation science has borrowed concepts from psychology to explain how individuals think and act in relation to innovation adoption, the use of psychology has been limited and not well adapted to the aims and obligations of professionals. We aimed to enrich implementation science with a broader set of psychological theories relevant for professional behaviour, drawing particularly on the diffusion of innovations and stages of change models. Methods The study had two parallel components. The first was a hermeneutic review of how psychological theory has and could be used to understand innovation adoption by health professionals. The second component was an empirical case study of the implementation of guidance on routine HIV screening in three sites across two London hospitals. Primary data sources were synthesised and combined with emerging secondary research findings, each feeding into the other. Analysis focused empirically on how the stages of the diffusion of innovations adoption model (prior conditions, knowledge, persuasion, decision, implementation, confirmation) could be enriched by psychological theories. Results The hermeneutic review identified at least 20 relevant psychological theories from social, organisational, developmental and sports psychology; many of these were not single theories but contributions from domains of evolving research, making this an underestimate of potentially relevant theory. We developed a model (PHOENIX) to encapsulate how psychological theory can help illuminate each stage of adoption from diffusion of innovations theory: Person and History (prior conditions stage) – individuals’ characteristics and past experiences; Overload avoidance (knowledge stage) – filtering strategies when faced with overwhelming amounts of new knowledge; Evolving attitudes (persuasion stage) – a social process of collectively emerging views within a team; Networked decisions (decision stage) – decisions at two levels of the department combined with individual judgements; Implementation support (implementation stage) to turn an intention to act into actual action, with external supports valuable to reduce the cognitive effort required; uneXceptional (confirmation stage) – sustained effort to turn the new behaviour from a conscious innovation to a habit. Conclusions The PHOENIX model, if affirmed in further studies, has potential to enrich the study of innovation adoption by healthcare staff in organisational and professional contexts.
The bright elusive butterfly of value in health technology development: Comment on “providing value to new health technology: The early contribution of entrepreneurs, investors, and regulatory agencies”
The current system of health technology development is characterised by multiple misalignments. The “supply” side (innovation policy-makers, entrepreneurs, investors) and the “demand” side (health policy-makers, regulators, health technology assessment, purchasers) operate under different – and conflicting – logics. The system is less a “pathway” than an unstable ecosystem of multiple interacting sub-systems. “Value” means different things to each of the numerous actors involved. Supply-side dynamics are built on fictions; regulatory checks and balances are designed to assure quality, safety and efficacy, not to ensure that technologies entering the market are either desirable or cost-effective. Assessment of comparative and cost-effectiveness usually comes too late in the process to shape an innovation’s development. We offer no simple solutions to these problems, but in the spirit of commencing a much-needed public debate, we suggest some tentative ways forward. First, universities and public research funders should play a more proactive role in shaping the system. Second, the role of industry in forging long-term strategic partnerships for public benefit should be acknowledged (though not uncritically). Third, models of “responsible innovation” and public input to research priority-setting should be explored. Finally, the evidence base on how best to govern inter-sectoral health research partnerships should be developed and applied.
The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure
Background: Until COVID-19, implementation and uptake of video consultations in health care was slow. However, the pandemic created a "burning platform"for scaling up such services. As health care organizations look to expand and maintain the use of video in the "new normal,"it is important to understand infrastructural influences and changes that emerged during the pandemic and that may influence sustainability going forward. Objective: This study aims to draw lessons from 4 National Health Service (NHS) organizations on how information infrastructures shaped, and were shaped by, the rapid scale-up of video consultations during COVID-19. Methods: A mixed methods case study of 4 NHS trusts in England was conducted before and during the pandemic. Data comprised 90 interviews with 49 participants (eg, clinicians, managers, administrators, and IT support), ethnographic field notes, and video consultation activity data. We sought examples of infrastructural features and challenges related to the rapid scale-up of video. Analysis was guided by Gkeredakis et al's 3 perspectives on crisis and digital change: as opportunity (for accelerated innovation and removal of barriers to experimentation), disruption (to organizational practices, generating new dependencies and risks), and exposure (of vulnerabilities in both people and infrastructure). Results: Before COVID-19, there was a strong policy push for video consultations as a way of delivering health care efficiently. However, the spread of video was slow, and adopting clinicians described their use as ad hoc rather than business as usual. When the pandemic hit, video was rapidly scaled up. The most rapid increase in use was during the first month of the pandemic (March-April 2020), from an average of 8 video consultations per week to 171 per week at each site. Uptake continued to increase during the pandemic, averaging approximately 800 video consultations per week by March 2021. From an opportunity perspective, participants talked about changes to institutional elements of infrastructure, which had historically restricted the introduction and use of video. This was supported by an "organizing vision"for video, bringing legitimacy and support. Perspectives on disruption centered on changes to social, technical, and material work environments and the emergence of new patterns of action. Retaining positive elements of such change required a judicious balance between managerial (top-down) and emergent (bottom-up) approaches. Perspectives on exposure foregrounded social and technical impediments to video consulting. This highlighted the need to attend to the materiality and dependability of the installed base, as well as the social and cultural context of use. Conclusions: For sustained adoption at scale, health care organizations need to enable incremental systemic change and flexibility through agile governance and knowledge transfer pathways, support process multiplicity within virtual clinic workflows, attend to the materiality and dependability of the IT infrastructure within and beyond organizational boundaries, and maintain an overall narrative within which the continued use of video can be framed.
Theorising the shift to video consulting in the UK during the COVID-19 pandemic: Analysis of a mixed methods study using practice theory
We studied video consulting in the National Health Service during 2020–2021 through video interviews, an online survey and online discussions with people who had provided and participated in such consultations. Video consulting had previously been used for selected groups in limited settings in the UK. The pandemic created a seismic shift in the context for remote consulting, in which video transformed from a niche technology typically introduced by individual clinicians committed to innovation and quality improvement to offering what many felt was the only safe way to deliver certain types of healthcare. A new practice emerged: a co-constitution of technology and healthcare made possible by new configurations of equipment, connectivity and physical spaces. Despite heterogeneous service settings and previous experiences of video consulting, we found certain kinds of common changes had made video consulting possible. We used practice theory to analyse these changes, interpreting the commonalities found in our data as changes in purpose, material arrangements and a relaxing of rules about security, confidentiality and location of consultations. The practice of video consulting was equivocal. Accounts of, and preferences for, video consulting varied as did the extent to which it was sustained after initial take-up. People made sense of video consulting in different ways, ranging from interpreting video as offering a new modality of healthcare for the future to a sub-optimal, temporary alternative to in-person care. Despite these variations, video consulting became a recognisable social phenomenon, albeit neither universally adopted nor consistently sustained. The nature of this social change offers new perspectives on processes of implementation and spread and scale-up. Our findings have important implications for the future of video consulting. We emphasise the necessity for viable material arrangements and a continued shared interpretation of the meaning of video consulting for the practice to continue.
Clinical risk in remote consultations in general practice: findings from in-COVID-19 pandemic qualitative research
Background: The COVID-19 pandemic-related rise in remote consulting raises questions about the nature and type of risks in remote general practice. Aim: To develop an empirically based and theory-informed taxonomy of risks associated with remote consultations. Design & setting: Qualitative sub-study of data selected from the wider datasets of three large, multi-site, mixed-method studies of remote care in general practice before and during the COVID-19 pandemic in the UK. Method: Semi-structured interviews and focus groups, with a total of 176 clinicians and 43 patients. Data were analysed thematically, taking account of an existing framework of domains of clinical risk. Results: The COVID-19 pandemic brought changes to estates (for example, how waiting rooms were used), access pathways, technologies, and interpersonal interactions. Six domains of risk were evident in relation to the following: (1) practice set-up and organisation (including digital inequalities of access, technology failure, and reduced service efficiency); (2) communication and the clinical relationship (including a shift to more transactional consultations); (3) quality of clinical care (including missed diagnoses, safeguarding challenges, over-investigation, and over-treatment); (4) increased burden on the patient (for example, to self-examine and navigate between services); (5) reduced opportunities for screening and managing the social determinants of health; and (6) workforce (including increased clinician stress and fewer opportunities for learning). Conclusion: Notwithstanding potential benefits, if remote consultations are to work safely, risks must be actively mitigated by measures that include digital inclusion strategies, enhanced safety-netting, and training and support for staff.
Remote care in UK general practice: baseline data on 11 case studies
Background: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs. Methods: : Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data. Results: : Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features—notably system-level stressors such as high workload and staff shortages, and UK’s technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the ‘digital front door’ (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts. Conclusions: : General practices’ responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.
Remote care in UK general practice: baseline data on 11 case studies.
BackgroundAccessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs.MethodsMixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data.ResultsReflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features-notably system-level stressors such as high workload and staff shortages, and UK's technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the 'digital front door' (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts.ConclusionsGeneral practices' responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.