Remote-by-Default 2: the new normal

Exploring the benefits and drawbacks of remote care
Young GP physician and elderly female patient consulting over video call. A virtual medical health check-up with doctor instead of an in-practice appointment during the COVID-19 pandemic

Overview

Primary Care is facing enormous demand and capacity pressures. Technology has been heralded as part of the solution but its implementation has been far from plane sailing, and the loss of a traditional face-to-face GP service threatens the core values of primary care. Remote by Default 2: the new normal (RBD2) explores both the benefits and drawbacks of remote care and explores the potential models such as blended (remote and face-to-face) approaches.
RBD2 is an NIHR Health Services and Delivery Research Programme which builds on our previous study of in-pandemic remote care in UK general practice during the COVID-19 pandemic. It is led by Professor Trisha Greenhalgh from the University of Oxford and collaborates with the Nuffield Trust and Thrive by Design. The project follows 11 general practices for two years, exploring how they introduce, refine, and in some cases work around remote care solutions.
The project seeks 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.
Dr Sarah Rybczynska-Bunt and Professor Richard Byng are leading on the Plymouth sites, which will focus on the impact of remote by default on inequalities and work closely with the ‘Deep End’ group of practices. 

Project aims

RBD2 aims to answer the following 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?

Methods

To carry out our research, we will:
  1. Build mixed-methods longitudinal case studies to support practices through action research and two digital inclusion co-design workshops.
  2. 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.
  3. Workshops and scenario-testing: Involving policymakers, regulators, professional bodies, industry, patients/citizens, to identify ways to deliver and support a more equitable, less risky remote-by-default service.

Deliverables: 

Our activities throughout the project include:
  • Two years of action research with 11 GP practices to help deliver their priority goals
  • Four digital inclusion workshops to help co-design ways to combine remote and face-to-face models.
  • Four cross-sector stakeholder events with follow-on support for policy action one how to deliver and support a more equitable, less risky remote-by-default service
  • Strengthened infrastructure for supporting digital innovation in the NHS.

Patient and Public Involvement 

We have actively involved patients in the design for the Remote by Default: care in the Covid-19 pandemic (RBD1) and Remote-by Default 2: the new normal (RBD2). These studies are looking into the impact of remote care (online, over the phone, through video) has on patients. Our patient engagement work centred on three core principles:
  • Establish a diverse group of people, representative of different patient populations
  • Use novel approaches to include digitally excluded people and ensure the participation of seldom-heard voices
  • Generate generalizable shared learning and develop co-designed practical outputs

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Project collaborators

RBD2 is a University of Oxford Study led by Trisha Greenhalgh and Sara Shaw. The research team include academic GPs, nurses, managers, and social scientists who specialise in the evaluation of technology in social context. The project works closely with the Nuffield Trust (Rebecca Rosen) and Thrive by Design, (Roz Davies) a digital inclusion design service. The project has an External Executive Group involving key national stakeholders and led by Anica Alvarez Nishio.