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Workstream 4: Service redesign in primary care: realist reviews and mixed methods
Over 50 million people in England are cared for by the NHS, and about 90% have their first NHS contact with a GP. However, primary care services, specifically UK general practice, are currently under considerable pressure. The NHS England GP Forward View advocates investing in and developing new models of care, however, these innovations should be underpinned by a robust evidence base. This stream of work will answer key questions to support the redesign of primary care. By systematically identifying and synthesising existing evidence, our work will support improved services for patients, clinicians and policymakers.
Workstream 2: End of life care and bereavement
The “average” GP practice in England has 54 deaths per year, leaving 260 people affected by bereavement. Bereavement is an important cause of mortality and morbidity especially among older people and those who are socially isolated, influencing both physical and mental health, and the ability to function at work. Around 10% of bereaved people develop complicated grief following the loss of a loved one, which requires specific targeted treatment for which there is currently little guidance.
Workstream 3: Assessing new drugs and technologies in chronic disease patients using unpublished data sources
There is good evidence that trial reports in academic journals represent an incomplete picture of the data collected, and are an unsatisfactory source of information. Our recent Cochrane review highlighted the existence of unpublished data (which often contains negative data) for newer oral anticoagulant drugs, which has net been assessed, and there are reports of several side effects related to GLP-1 analogues and newer anti-obesity drugs that have not yet been reviewed. We are therefore planning a series of complex systematic reviews that include regulatory documents and Clinical study reports to evaluate new drugs and some technologies in widespread use where there is uncertainty about the benefit and harms profiles.
Workstream 1: Urgent care interface
Unplanned hospital admissions are a major concern for UK health services, costing an estimated £12.5 billion annually. Many are for older people who are more likely to end up in the hospital; if they do, they may get stuck there due to a lack of community resources. Thus community-based models of care need to be developed based on robust evidence synthesis to address this pressing need. Similarly, NHS England has proposed an enhanced service to provide more personalised support for patients most at risk of unplanned admission, readmission and A&E attendances, but currently, the evidence for advanced care planning is lacking.
Evidence Synthesis Training and Capacity Development
The training and capacity theme is led by five of the ESWG co-applicants and draws on expertise from across the nine SPCR centres. The key objective for the ESWG group is to provide training, build capacity and propagate best practice in conducting systematic reviews and evidence synthesis.