Remote and digital services in UK general practice 2021-2023: the Remote by Default 2 longitudinal qualitative study synopsis.

Background: Remote services (in which the patient and staff member are not physically colocated) and digital services (in which a patient encounter is digitally mediated in some way) were introduced extensively when the COVID-19 pandemic began in 2020. We undertook a longitudinal qualitative study of the introduction, embedding, evolution and abandonment of remote and digital innovations in United Kingdom general practice. This synoptic paper summarises study design, methods, key findings, outputs and impacts to date.

After the disruptive innovation: How remote and digital services were embedded, blended and abandoned in UK general practice - longitudinal study.

Background: United Kingdom general practices transitioned rapidly to remote-by-default services in 2020 and subsequently considered whether and how to continue these practices. Their diverse responses provided a unique opportunity to study the longer-term embedding, adaptation and abandonment of digital innovations. Research questions: What was the range of responses to the expansion of remote and digital triage and consultations among United Kingdom general practices in the period following the acute phase of the coronavirus disease discovered in 2019 (COVID-19) pandemic? What can we learn from this example about the long-term impacts of crisis-driven sociotechnical change in healthcare settings?

Methods: We collected longitudinal data from 12 general practices from 2021 to 2023, comprising 500 hours of ethnographic observation, 163 interviews in participating practices and linked organisations (132 staff, 31 patients), 39 stakeholder interviews and 4 multi-stakeholder workshops (210 participants), with additional patient and public involvement input.

International healthcare workers' experiences and perceptions of the 2022 multi-country mpox outbreak.

In May 2022, the most widespread outbreak of sustained transmission of mpox outside of countries historically affected countries in Western and Central Africa occurred. We aimed to examine the personal and clinical experiences of international healthcare workers (HCWs) during this public health emergency. We conducted an international cross-sectional survey study between August and October 2022, examining the experiences and perceptions of HCWs clinically involved in the 2022 mpox response.

Technostress, technosuffering, and relational strain: a multi-method qualitative study of how remote and digital work affects staff in UK general practice.

Background: The introduction of remote and digital forms of working in UK general practice has driven the development of new routines and working styles.

Aim: To explore and theorise how new forms of work have affected general practice staff.

Design And Setting: Multi-sited, qualitative case study in UK general practice.

Challenges to quality in contemporary, hybrid general practice a multi-site longitudinal case study.

Background: Since 2022, general practice has shifted from responding to the acute challenges of COVID-19 to restoring full services using a hybrid of remote, digital, and in-person care.

Aim: To examine how quality domains are addressed in contemporary UK general practice.

Design And Setting: Multi-site, mostly qualitative longitudinal case study, placed in UK national policy context.

Access and triage in contemporary general practice: A novel theory of digital candidacy.

To access contemporary healthcare, patients must find and navigate a complex socio-technical network of human and digital actors linked in multi-modal pathways. Asynchronous, digitally-mediated triage decisions have largely replaced synchronous conversations between humans. In this paper, we draw on a large qualitative dataset from a multi-site study of remote and digital technologies in general practice to understand widening inequities of access.

Cross-sectional survey of sexual health professionals' experiences and perceptions of the 2022 mpox outbreak in the UK.

Objective: To understand the experiences and perceptions of sexual health professionals responding to the May 2022 mpox outbreak in the UK.

Design: Cross-sectional, anonymous, online survey collecting quantitative and qualitative data. Convenience sample recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media.

Training needs for staff providing remote services in general practice: a mixed-methods study.

Background: Contemporary general practice includes many kinds of remote encounter. The rise in telephone, video and online modalities for triage and clinical care requires clinicians and support staff to be trained, both individually and as teams, but evidence-based competencies have not previously been produced for general practice.

Aim: To identify training needs, core competencies, and learning methods for staff providing remote encounters.

Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis.

Background: Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents occur in remote encounters and how to prevent them.

Setting And Sample: UK primary care.

Why is safety in intrapartum electronic fetal monitoring so hard? A qualitative study combining human factors/ergonomics and social science analysis.

Background: Problems in intrapartum electronic fetal monitoring with cardiotocography (CTG) remain a major area of preventable harm. Poor understanding of the range of influences on safety may have hindered improvement. Taking an interdisciplinary perspective, we sought to characterise the everyday practice of CTG monitoring and the work systems within which it takes place, with the goal of identifying potential sources of risk.

A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy.

Objective: We aimed to explore the experiences and perspectives of pregnant women, antenatal healthcare professionals, and system leaders to understand the impact of the implementation of remote provision of antenatal care during the COVID-19 pandemic and beyond.

Methods: We conducted a qualitative study involving semi-structured interviews with 93 participants, including 45 individuals who had been pregnant during the study period, 34 health care professionals, and 14 managers and system-level stakeholders. Analysis was based on the constant comparative method and used the theoretical framework of candidacy.

Remote care in UK general practice: baseline data on 11 case studies.

Background: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs.

Methods: Mixed-methods (mostly qualitative) case study across 11 general practices.

Protocol: Remote care as the 'new normal'? Multi-site case study in UK general practice.

Background: Following a pandemic-driven shift to remote service provision, UK general practices offer telephone, video or online consultation options alongside face-to-face. This study explores practices' varied experiences over time as they seek to establish remote forms of accessing and delivering care.

Methods: This protocol is for a mixed-methods multi-site case study with co-design and national stakeholder engagement.

Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders.

Background: High-quality antenatal care is important for ensuring optimal birth outcomes and reducing risks of maternal and fetal mortality and morbidity. The COVID-19 pandemic disrupted the usual provision of antenatal care, with much care shifting to remote forms of provision. We aimed to characterise what quality would look like for remote antenatal care from the perspectives of those who use, provide and organise it.