Remote by Default 2: the “new normal”?
To inform high-quality, safe and equitable care in UK general practice in the context of policies which require phone, video or e-consultation by default.
Should general practice provide remote consultations (that is, telephone, video or e-consultations instead of traditional face-to-face ones) ‘by default’? If so, to whom and how? If not, why not?
UK general practice is currently under unprecedented pressure as pandemic workload combines with non-pandemic backlog at a time when staff are already exhausted. Technology is not a magic solution to this problem. Loss of the traditional face to face GP service threatens the core values of primary care. Trainees in particular are finding the shift to remote a challenge, though some may also welcome the flexibility of remote working. We question the unbridled enthusiasm for technological solutions from some quarters, but we also know that amongst the many technologies produced in this digital pandemic there are some with real potential to support new models of care such as a blended (remote and face-to-face) approach to long-term condition management.
All this needs proper research. We are delighted to have been awarded £895,000 from the NIHR Health Services and Delivery Research programme for the RBD2 study, which will follow 11 general practices for two years, starting Sept 1st 2021, and explore how they introduce, refine, and in some cases work around remote care solutions.
This new research study, ‘Remote by Default 2’ or RBD2, builds on our previous study of in-pandemic remote care in UK general practice during the pandemic.
Who is doing the study?
The study is led from the University of Oxford, with joint Chief Investigators Trish Greenhalgh and Sara Shaw. They are working with University of Plymouth (Richard Byng), Nuffield Trust (Rebecca Rosen) and Thrive by Design, an in-house NHS consultancy with expertise in the co-design of inclusive digital transformation of health and care services (Roz Davies). Our staff include academic GPs, nurses, managers, and social scientists who specialise in the evaluation of technology in social context. We have extensive patient and lay involvement (lead: Anica Alvarez Nishio)
What are the research questions?
- How can we ensure that the remote-by-default model supports high-quality, safe care to all patients (including those at risk of digital exclusion)?
- How can we balance a remote-by-default model with the provision of traditional face-to-face consultations where appropriate?
- How can we meet the wellbeing and training needs of general practice staff as remote-by-default becomes business as usual?
- What are the infrastructural challenges of remote-by-default and how can they be overcome?
What are the deliverables?
- Two years of action research with 11 GP practices to help deliver their priority goals
- Four digital inclusion workshops help co-design ways to combine remote and face-to-face models.
- Four cross-sector stakeholder events with follow-on support for policy action one how to deliver and support a more equitable, less risky remote-by-default service
- Strengthened infrastructure for supporting digital innovation in the NHS.
What are the methods?
- Build mixed-methods longitudinal case studies to support practices through action research and two digital inclusion co-design workshops.
- 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.
- Workshops and scenario-testing: Involving policymakers, regulators, professional bodies, industry, patients/citizens, to identify ways to deliver and support a more equitable, less risky remote-by-default service.
Related project – Remote by default; previous study of in-pandemic remote care
Funded by: This project was funded by the National Institute for Health Research
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