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Remote-by-Default Care in the COVID-19 Pandemic: addressing the micro, meso and macro-level challenges of a radical new service model

Professor in Primary Care Research and PenARC Deputy Director Richard Byng is part of a new project funded by the Economic and Social Research Council through UKRI’s Ideas to Address COVID-19 call. The team, led by Professor Trisha Greenhalgh from the University of Oxford, and also including researchers from the Nuffield Trust, has been awarded £750,000 for the study, Remote-by-Default Care in the COVID-19 Pandemic.

Richard, who is a practising GP in Plymouth will be leading investigation of the implementation and scale-up of ‘remote-by-default’ working, where patients can no longer automatically access face-to-face appointments, as a result of COVID-19 in Plymouth. 

The Plymouth arm of the study will focus on the impact of these changes on those living in poverty and from marginalised groups. Researchers will work closely with the Deep End group of practices, a network of GP practices that cover the most deprived patient areas in the city, as well as the Devon Clinical Commissioning Group.

Professor Byng said: “While we have seen some advantages to the increased use of telephone, video and email based consultation, there are significant challenges, especially for those without the best phones, without credit and without homes, as well as for those living with frailty, mental health problems or learning difficulties. We will investigate these challenges and help support the best mix of face-to-face and remote working for these groups.”

The wider 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.

Background

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.

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?

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.

Deliverables:

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.

Outputs:

Keep up to date with the outcomes of the study on the University of Plymouth Project Page 

 

 

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