Title: Evaluating video and hybrid group consultations in general practice: mixed-methods, participatory study
Funder: Department of Health and Social Care

Abstract: AIM_x000D_ To better understand how group consultations for chronic conditions can benefit patients and the health service when delivered on video and/or in-person sessions in general practice._x000D_ _x000D_ BACKGROUND_x000D_ Before the pandemic, group consultations were starting to gain ground in the UK as a new way of delivering clinical care to multiple patients at the same time, with potential benefits resulting from peer support and time efficiencies. When in-person care was restricted due to Covid-19, clinicians started delivering group consultations over video, supported by a training programme commissioned by the government. Despite significant interest, we still know little about how group consultations delivered over video or hybrid models combining video and in-person sessions can be best implemented._x000D_ _x000D_ STUDY DESIGN AND METHODS_x000D_ The project will begin with an online, UK-wide survey to find out about video and in-person group consultations delivered in general practice: for which patient groups and purposes are they delivered, to what extent, and in what formats. We will then work closely with patients, clinical and non-clinical general practice staff to understand how group consultations can be designed and delivered to provide maximum value. In 5 GP practices across England, where group consultations are already being delivered, we will evaluate how these new approaches to clinical care are implemented, and how they may support an inclusive service that engages patients with different needs and preferences. The evaluation will include interviews with patients, carers, NHS staff, policy-makers and commissioners, as well as group discussions and observations, including research led by patients themselves. We will also collect numerical data on the number and type of patients attending, whether they are more satisfied or confident with their self-management, or less likely to need to go to hospital. We will explore costs associated with these new ways of delivering care and will develop comparisons to face-to-face individual appointments. With the involvement of our PPI group, we will bring together our data to develop practical knowledge._x000D_ _x000D_ PATIENT AND PUBLIC INVOLVEMENT_x000D_ We are working with PPI contributors and charity organisations to shape the research design, study materials and outputs. Our PPI group includes people with a range of conditions, ages, genders and ethnicities. _x000D_ _x000D_ DISSEMINATION _x000D_ We will tailor our outputs for different audiences: user-friendly guides for patients/carers, implementation resources for service providers, briefings and presentations for policymakers/commissioners, and peer-reviewed, high-impact journal articles and conference presentations for academics/researchers.

Lay abstract: BACKGROUND_x000D_ General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. In early 2020 NHS England commissioned a training programme on video group consultations in general practice, with NHS Wales following suit. Despite positive initial findings and much enthusiasm, there are still gaps in the evidence base on video group consultations (and hybrid formats combining in-person sessions) and their impact on patient experience and healthcare utilisation, quality and safety, equity and affordability._x000D_ _x000D_ AIM_x000D_ To generate a strong evidence base for successful co-design and implementation of Video and Hybrid Group Consultations (VHGCs) for chronic conditions in general practice._x000D_ _x000D_ RESEARCH QUESTIONS_x000D_ 1.What is the feasibility and acceptability of VHGCs to different population groups? What are their implications for access, satisfaction, efficiency and safety in general practice?_x000D_ 2.How do patients, carers and NHS staff experience these new models of care, compared to standard one-to-one service provision and face-to-face only group consultations?_x000D_ 3.What are the costs of introducing VHGCs? What is the organisational impact on general practice and other system-level stakeholders?_x000D_ 4.What would be the optimal design of a large-scale evaluation to assess clinical benefits and key outcome/activity parameters?_x000D_ _x000D_ STUDY DESIGN AND METHODS_x000D_ Mixed-methods, multi-site research study using co-design and participatory methods, to generate actionable learning on VHGC implementation, from qualitative, quantitative and cost-related perspectives. The study consists of 3 interlinked work-packages (WP). WP1 includes a national, cross-sectional survey on VHGC provision in general practice across the UK. In WP2 we will engage patients and general practice staff in co-design workshops to develop VHGC models with emphasis on digital inclusion and equity. In WP3 we will carry out a mixed-methods process evaluation in 10 GP practices across England (5 sites already running VHGCs and 5 control sites). Qualitative methods will include interviews, focus groups and ethnographic observation to examine the experiences of patients, carers, clinical and non-clinical NHS staff, commissioners and policy-makers. Drawing on participatory principles, we will also work with up to 4 patients as co-researchers. Quantitative methods will examine the impact of VHGCs on healthcare utilisation in primary and secondary care, patient satisfaction, engagement and activation. We will also assess value for money of group and individual care models from a health economics perspective. There will be ongoing dialogue and synthesis between the different work streams, and patients and public contributors will be involved throughout. _x000D_ _x000D_ TIMELINES_x000D_ 24-month project, starting March 2022. _x000D_ _x000D_ IMPACT AND DISSEMINATION_x000D_ We will support practices to co-design and refine VHGC models that improve quality, equity and efficiency. We will also inform local and national strategy, through ongoing relationships with decision-makers (e.g. NHSE, NHSX) and policy briefings. In addition to high-quality journal articles and conference presentations, we will produce VHGC implementation guides and public-facing resources (including translation).

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE