Remote by Default 2: the 'new normal'?

BACKGROUND

The remote-by-default policy in UK general practice, introduced for infection control during the acute phase of the pandemic, seems likely to be continued long term. There are unanswered questions about how to optimise this service model. AIM

To inform a more fit-for-purpose remote-by-default model in general practice which takes account of a) quality and safety of care, b) equity and inclusivity, c) staff wellbeing and training, and d) the wider technical and regulatory infrastructure. RESEARCH QUESTIONS

1. 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)?

2. How can we balance a remote-by-default model with the provision of traditional face-to-face consultations where appropriate?

3. How can we meet the wellbeing and training needs of general practice staff as remote-by-default becomes business as usual? 4. What are the infrastructural challenges of remote-by-default and how can they be overcome? STUDY DESIGN Mixed-method, multi-site case study with co-design workshops and cross-sector stakeholder events.

OBJECTIVES AND BRIEF METHODS 1. PRACTICE LEVEL

Objective: Follow a maximum-variety 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.

Methods: Build mixed-methods longitudinal case studies via staff interviews, document analysis, ethnography (adapted to virtual if necessary). Support practices through action research and 2 digital inclusion co-design workshops. 2. PATIENT LEVEL

Objective: 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. Methods: 40 interviews and 2 digital inclusion co-design workshops with patients and carers.

3. SYSTEM LEVEL

Objective: Engage 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. Methods: 20 elite interviews plus 4 stakeholder events (see below)

PATIENT AND PUBLIC INVOLVEMENT (PPI)

• External advisory group with independent lay chair and wide range of lay members bringing cross-sector experience from (e.g.) industry, 3rd sector, arts, policy • Patient/lay input to study design • PPI virtual group with buddying of others not fully online • Innovative approaches to involvement described in main bid

KEY DELIVERABLES • 4 digital inclusion co-design workshops (2 for patients and carers, 2 for GP practice staff)

• Report on diversity of patient experience of remote-by-default, plus digital inclusion personas to feed into other design activities • 2-years of action research with 10 GP practices to help deliver their priority goals • Written case studies and cross-case analysis of practices’ experiences

• 4 large-scale cross-sector stakeholder events with preparatory and follow-up activities with policy, NHS, industry and patient groups • Ongoing relationships and implementation action as invited with national-level stakeholders • Academic papers, policy briefings • Lay summaries and resources