SEARCH: Social and Ethical Aspects of Remote and Hybrid Care in the Special Allocation Scheme in general practice

Aims

This research aims to understand and inform primary care provision that is currently being provided to patients registered on the ‘Special Allocation Scheme’ (SAS). The SAS is a scheme that provides GP services to patients who have been excluded from their GP practice after being reported for aggressive or violent behaviour. Patients registered on the SAS are likely to be offered remote services, in part because patients are often placed in an ‘out of area’ SAS practice that provides the service to a large geographical area. Our aim is to find out more about the (digital/remote communication) needs of patients on the SAS, whether and when it is appropriate to offer remote options, and who these options might benefit or disadvantage. In addition, we aim to develop safe, ethical, and meaningful ways to involve patients who have experience on the scheme in research and service development.

Why is this important

There is currently extremely limited evidence available on who these patients are, what their potential (digital/remote communication) needs might be, and how this service can best be organised for patients and staff involved. We know that while remote care options can improve access to primary care for some, they are not suitable for every patient population, or at all times, and they can increase disparities and inequalities in health. It is likely that many patients registered on the SAS already experience multiple disadvantages, and it might be difficult for staff to know how best to support these patients.

There will be opportunities for patients to become directly involved in the research process. We hope this will improve the way that research is done with and for patients who experience exclusion in care. In addition, the overall study findings will provide insights into the accessibility, inclusivity, and quality of primary care services for patients on SAS, which can be used to inform the way care is delivered in future.

Methods

This is a mixed methods feasibility study using a combination of research methods as well as patient and public involvement.

We will start by finding out how and where care for patients on SAS is currently provided through a national survey. We will also explore perceived (digital/remote communication) needs and any current challenges experienced by providers.  We will then take a closer look at care provided to patients on SAS through observations and interviews with patients and staff at three diverse SAS providers across the country. We will also conduct interviews with policy and decision makers to explore how our findings relate to the way relevant services are designed on a national level.

We will prepare for this work by involving people who are experienced in working for and with patients on SAS, as well as patients who have lived experience of SAS and/or other forms of exclusion in care. This will help to make sure that our data collection plans and materials are safe, ethical, and sensitive.

We are working with Design Science to create resources that bring together learning from our research and PPI work, which we’ll make available to researchers and/or healthcare providers aiming to work on health service redesign or quality improvement for patients currently receiving care via SAS services.

Funding

This project is funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR 717)