Project 843 | Investigating research delivery in general practice

A key objective for the 10 year NHS plan is to move healthcare from hospitals to communities and neighbourhoods. There is increased recognition of the importance of embedding research into general practices and wider care settings but it remains unclear, how changing GP working practices (e.g., triage systems, e-consultations, and remote or hybrid consultations) are affecting participant recruitment into research and delivery of clinical studies. Existing research demonstrates that these shifts in working practices have significant impacts on workload, workflow, and the nature of clinician–patient interactions, with some studies reporting increased administrative burdens, and challenges in managing patient demand efficiently. Additionally, patients are now receiving healthcare from a wide spectrum of clinicians, from first contact practitioners and health care assistants to pharmacists and mental health practitioners. These new patterns of working need to be investigated and analysed to investigate and leverage opportunities to facilitate research in GP practices.

Aim

To understand how changes in GP practice working models affect current research engagement and study delivery and to identify key opportunities and processes that can be adopted to facilitate research engagement and efficient successful study delivery.

Research questions

1) How are current GP working models affecting research engagement and participant recruitment?
2) What opportunities are there with new working practices to enhance research engagement and delivery?
3) How can the role of multidisciplinary teams in GP practices support research engagement and participant recruitment?
4) What changes might be needed to study design, protocols, or recruitment methods to align research studies with current GP working models to enhance their research engagement?
5) How can digital systems (e.g. online triage tools, text messaging, patient portals) be better used to support research engagement, research signposting/alerts, participant recruitment and research delivery?

Methods

Using a mixed methods approach, we will collect data through three work packages (WPs).
WP1: we will conduct two focus groups; participants will comprise a combination of RDN GP speciality leads, primary care setting leads, patients and community members and GPs delivering research.
WP2: we will design and administer an online survey, in part developed from outputs in WP1 to assess the impact of new GP working models on research engagement, capacity, and participant recruitment in GP practices.
WP3: informed by WP1 & 2, we will use a Nominal Group Technique (NGT) and consensus methodology to codesign best practice recommendations aligned with evolving working models.

Outputs

Outputs and materials will inform a range of relevant stakeholders from governing bodies, ethical review panels and the Research Support Service to GP practices, Universities and clinical trials units. Findings will also identify recommendations for researchers to adapt their research design and delivery methods to enhance research engagement and delivery in GP practices.

Population/Participants

We will work in partnership with Research Delivery Networks (RDNs) and relevant speciality leads across the UK to participate and support recruitment for the focus groups and participants to the wider questionnaire study. In collaboration with RRDN teams, we will identify research active GPs practices with varying levels of research activity to ensure a broad range of perspectives are captured. A Community of Practice (CoP) group will be established, comprising representative members from GP practices with differing levels of research engagement, alongside a Patient and Public Involvement and Engagement (PPIE) group. Both groups will provide ongoing input to the study design, delivery, and dissemination. Our team have close links to the RDN and its relevant speciality and settings leads. 

Outcome

1) Mapping and understanding current GP practice working models and their effect on research engagement of Co-production of a toolkit to enhance GP practice research engagement;
2) Identification of opportunities to better integrate research into current primary care working models
3)Development of best practice recommendations for researchers to improve alignment of study design and recruitment approaches with modern GP working models
4) academic and non-academic dissemination outputs (e.g., academic publications, conference attendance, dissemination event, RDN specific materials)
5) Output materials to be disseminated to governance, ethics and study sponsor organisations to promote awareness and understanding of these models.

Study management

Professor Christian Mallen, Director of the NIHR School for Primary Care Research will lead this study in accordance with the School of Medicine Standard Operating Procedures. The core project team will have monthly meetings and will meet every two months with the CoP and PPIE groups. This team will monitor the progress of study; to identify and resolve issues and support dissemination planning.

Outputs and dissemination

The School of Medicine at Keele University has a well-established knowledge mobilisation unit which supports research to embed knowledge mobilisation, dissemination and impact into all aspects of our research. To disseminate our findings, we will publish in relevant peer-reviewed journals, present findings at GP practice conferences and host information, including case studies, on a study website to increase work visibility and wider knowledge exchange across the research, practicing community, CRDC and wider NIHR. We will use our professional networks to increase the impact of this work. We will also work with CoP to identify pathways to disseminate findings to the wider practice community. We will also share the findings and the toolkit through an accessible online resource and through direct engagement with, key additional organisations relating to governance (eg the MHRA), Ethics, study sponsors.