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We are an interdisciplinary team specializing in the study of complex, technology supported change in the health care settings. Using a variety of methodologies our work spans 2 work packages:

Workstream 1

What is the research plan?

AT PRACTICE LEVEL, we plan to follow a sample of 11 GP practices for 2 years as they seek to introduce, improve and sustain remote-by-default consultations, supporting them in developing effective remote services and equitable alternatives where needed. We will assign each practice a researcher-in-residence (who would work mostly virtually), to get to know the practice and develop an ongoing narrative of what’s happening and how it’s going. They will use staff interviews, documents such as practice protocols, and observation (e.g. attend virtual meetings if appropriate). We will bring the 11 practices together for virtual webinars and sharing ideas, and Thrive by Design will hold two online digital inclusion co-design workshops.

AT PATIENT LEVEL, we plan to capture the patient experience of remote-by-default consultations and ensure this perspective is incorporated in practice- and system-level efforts to improve and augment remote-by-default services. We will do this by undertaking patient interviews and holding digital inclusion co-design workshops for patients and carers. Patients recruited from the 11 practices will be linked via a ‘patient learning set’, with digitally-skilled patients supporting less skilled ones locally.

Workstream 2

AT SYSTEM LEVEL, we plan to engage senior-level stakeholders—including policymakers, professional bodies, industry, civil society and patient groups—in an ongoing dialogue about how to deliver and support a more equitable, less risky remote-by-default service. We’ll do this using what we call ‘élite interviews’ along with online stakeholder events via videoconference. This element of the study will ensure we have a channel for feeding our findings into policy.


What kinds of patients and issues will the study focus on?

We’re particularly interested in following four groups of patients:

  • People trying to get an appointment to see their own GP or practice nurse (patient-initiated consultations, especially those which reflect continuity of the clinical relationship);
  • People with long-term conditions such as diabetes, high blood pressure or asthma;
  • People with symptoms that could indicate a new diagnosis of cancer or other serious illness;
  • Older people with multi-morbidity, including those in care homes.


We’re also interested in four key issues, which we think will be illustrated by what happens with the four groups of patients listed above:

  • Quality and safety of clinical care;
  • Inequalities (how care is provided to the disadvantaged and the digitally excluded);
  • Well-being of staff (e.g. effects of a remote model on morale and mental health)—a theme that is closely linked to workload and demand;
  • Education and training (especially how students, trainees and early-career clinicians can become skilled and confident when much of clinical practice happens remotely).