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Addressing the micro, meso-, and macro-level challenges of a radical new service model

Man doing video conference with doctor on a laptop © Shutterstock

The ‘Remote by Default’ Covid-19 project, funded through the ESRC, is examining digital communications between patients and primary care practices. Led by Professor Trisha Greenhalgh from the University of Oxford, it also includes researchers from the University of Plymouth and the Nuffield Trust. The project is seeking to: develop tools to help clinicians assess people effectively by phone or video; support the change process through action research; and strengthen the supporting infrastructure for digital innovation in the NHS.


Because COVID-19 is so contagious, the way the NHS works has changed dramatically. For the first time since 1948, you can’t walk into a GP surgery>and ask to be seen. You must apply online, phone the surgery or contact NHS111. You may then get a call-back (phone or video) from a clinician, or a face-to-face appointment, possibly in a ‘hot hub’.

These changes to what used to be the family doctor service are radical. They cut to the core of what it is to care and be cared for, and what ‘good’ and ‘excellent’ health services look and feel like. Will the doctor be able to assess you properly by video or phone? Using a variety of methods, we want to do three things:

  • Develop tools to help clinicians assess people effectively by phone or video;
  • Support the change process through ‘action research’ – that is, working with GP teams to collect relevant data, analyse it together and support its rapid use;
  • Using collaborative improvement techniques, strengthen the supporting infrastructure for digital innovation in the NHS.

Outline methods:

1. Tools: Qualitative research to develop instruments followed by quantitative validation studies.

2. Implementation and scale-up: Four contrasting case studies in different localities. Action research (informed by interviews, ethnography, documents, datasets) by virtual researchers-in-residence.

3. Workshops and scenario-testing: Involving policymakers, regulators, professional bodies, industry, patients/citizens, to identify ways to strengthen infrastructure for rapid change.


1. At least two evidence-based assessment tools: qualitative (for remote assessment of key prognostic symptoms) and quantitative (a COVID-19-specific early warning score).

2. Transferable lessons about how to achieve rapid spread and scale-up, spread in real time through our extensive intersectoral networks.

3. Strengthened infrastructure for supporting digital innovation in the NHS.

Research questions:

1. How can technology support assessment and monitoring of patients at a distance?

2. How can we achieve rapid spread and scale up of remote-by-default models of primary care?

3. What insights can we glean from this time of crisis that will help build a more resilient NHS?

Further information:

Related project:

Remote COVID-19 Assessment in Primary Care (RECAP), NIHR Imperial Biomedical Research Centre

Funded by:

This project is funded by UK Research and Innovation (Economic and Social Research Council) and the National Institute for Health Research.