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  • Steven Robertson
  • Philip Oliver, Tony Ryan, Angela Tod

What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

Results from early collaborations with academic research unit and a covid-19 lead in primary care have shown that staff in primary care settings are less protected and safe compared to staff in secondary care settings during Covid-19 pandemic. Also, the initial findings from a RCN administered survey indicate that some primary care staff have been more protected than others. Our preliminary work with a cohort of ANP’s in primary care also suggests that there are differences in experience between primary and secondary care. Whilst there has been an organised blanket approach to organisation and planning for safe practice, the approach has been less organised in primary care. The main difference in primary care is that the initiative and the plan have been up to each practice cluster to decide upon and implement. The reason for these two findings has not yet been fully explored.

What does your project aim to achieve?

The aim of this research is to identify the processes which enable safe working in primary care by involving stakeholders to identify what the important factors are. By measuring the presence and/or absence of key factors in case studies of practices across the UK, we will describe the processes and key conditions that enable staff and patient safety. This will be a lesson for all successful and less successful practices in implementing safe practice. We expect to be able to make recommendations that could reduce risk to health care professionals in primary care settings.

How will the project be delivered?

Our study will be carried out in three phases.

Phase I will be primarily to collect qualitative and quantitative data in order to identify barriers and enablers as well as provide data to identify case studies for Part II. We will invite all participants in Part I to consent to taking part in Part II of the study.  Part II of the study will involve interviews with participants from case study (primary care sites). Findings from Part II of the study will then be used as a basis for workshops with participants and CCGs (Phase III). The aim of this final phase III will be to co-create best practice guidelines and develop policy recommendations with the phase II participants and a local CCG.

We will work with the Clinical Research Network (CRN) leads and GP leads in the CRN clusters, and the Primary Care Services research group for recruitment support.

How is your project going to share learning?

The knowledge transfer of best practice guidelines to primary care practices and professionals would help improve respiratory virus transmitted safety and shielding practices. The policy recommendations would help demonstrate some of the resource and process factors at an organisational and system level that might be required to facilitate this best practice and thereby help improve safety at this organisational and system level. Currently, there is no foreseeable end to the ongoing Covid-19 pandemic. The eradication of Covid-19 Is unlikely until there is an effective vaccine. Therefore, any findings that have an impact on safety by reducing transmission can bring valuable improvement to the current situation. Health care services and in particular, primary care services are facing unprecedented challenges. Any knowledge generated from this research could be beneficial to any future similar pandemic outbreak. In particular, for best approach to safe management and delivery of health services in primary care.

How you can contribute

  • Comments on variables:
  • Proportion of Complex Patients (complex patients may require face-to-face etc.)
  • Respondent’s: Grade, Years in Service, Age, Pre-existing conditions, Full time/Part-time, Type of Role, Sub-setting (would allow to determine who can shield) Team Size (Small teams may not be able to rotate and may work more frequently)
  • Access to Information and Guidance
  • Team Cohesion/ Teamwork (Not supported by the team may mean more exposed)
  • Patient Demographics
  • Implemented Policy/own strategy and coping system
  • Workload Changes (due to lack of support from Specialist Routine Services in Secondary Care not running), COVID cases
  • Support (mental health, physical health, other)
  • Team Demographics (Age, Sex, BAME, proportion who are in the Risk group) Training and Equipment (training provision how to stay safe, PPE)
  • Staffing Levels Pre-Covid
  • Leadership and Communication
  • Staffing Levels during Covid-19 outbreak Sickness Rate
  • Patient Population (Patient demographics eg. Age, ethnicity, socio-economic etc)
  • Preparation
  • Use of Digital Technologies

Plan timeline

1 Apr 2021 First Stakeholder involvement
1 May 2021 Ethical and Governance Approval
1 Jun 2021 Recruitment of Practice Clusters, Data Collection
1 Aug 2021 Data Analysis part I
1 Sep 2021 Part II Case Studies Data Collection
1 Nov 2021 Data Analysis, Integration of Part I and Part II Findings
1 Dec 2021 Co-creation workshop with CCGs and local stakeholder groups
1 Apr 2022 Collation of Findings and Start of Dissemination, HF Report

Comments

  1. Michaela,

    This is a great idea and I do hope that you take it forward. If you need any process visualizations done then please let me know as I'd love to help. Good luck with your idea.

    Tom

    1. Thank you Tom. Your help would be much appreciated. I am very much hoping that we can take this project forward!

  2. This sounds like a really useful and timely project. Have you thought about how you will define what safe practice is? Will it be based on international, national or regional guidelines, or will it be how or whether the individual practitioner feels safe (with some sort of scoring system)? Wishing you all the best and good luck!

    1. Thank you Tamar for taking time to read and comment!

      We will base 'safe' or not safe on HPs individual score. We will then compare and contrast this against whether the practice adopted regional and national guidelines as they do not necessarily address or apply to all circumstances and individuals.

      Best wishes

      Michaela

       

  3. Hi Michaela,

    This looks like a very timely and necessary piece of work.

    One thing to look at when considering changes to workload is whether that has involved working outside the practice in other areas such as care homes and whether that has been limited to one practitioner (limits risk to team but increases risk to individual).

    Good luck!

     

    Evelyn

    1. Thank you Evelyn for your comment.

      Certainly, we would aim to capture where and how the risk has been offset. It may have been, as you point out, controlled by reducing the risk to team but has then placed greater risk on one individual and vice versa.

  4. Hi

    One of the considerations maybe the CCG approach to risk and risk assessments the organisation I work for works across CCGS North to South in General practice / UTC and the variance has been staggering, in the approach to staff safety and welfare.

    Are you also looking at availability of digital technologies in maintaining primary care teams safety?

    1. Dear Janet

      Thank you for your very useful comments.

      I agree with you that there has been a huge variance in approach to staff safety and welfare. Use of digital technologies for remote consultations is a variable that will be included. For each outcome, we want to look at what factors have  enabled adoption of  risk-aversive measures and for whom.

       

  5. I am currently working as lead GP for two Urgent Treatment Centres.

    We have been seeing patients face to face throughout, and wearing the standard mask, apron and gloves for all patients, assuming all have Covid-19.

    The only two members of staff known to have caught Covid-19 did so before this became policy in March.

    I have spoken to some GPs who say they feel this is not enough and they need to be wearing much more. I don't know how your initial data was collected, but "staff in primary care settings are less protected and safe compared to staff in secondary care settings" may also be a subjective statement.

    Is it worth looking outside GP practices at other primary care settings, and community teams as well?

    I assume pre-phase 1 will be setting the baseline of what PPE is considered adequate; whether that is PHE guidance or otherwise.

    1. Dear Ian

      Thank you for your feedback. It is very useful. The proposal is looking at all aspects of safe working (not just PPE access).

      The statement re primary vs secondary care and PPE access was published in a report by the RCN.

      We would like to look at all settings but we are limited because of time and resources. It would be a very interesting and important thing to expand it to include community teams and other primary care settings.

      Therefore, the aim is to look at factors and conditions which enable staff to be/feel safe/at higher risk. This will be a self-reported/self perceived variable tested against independent variables such as:

      Proportion of Complex Patients (complex patients may require face-to-face etc.)
      Respondent’s: Grade, Years in Service, Age, Pre-existing conditions, Full time/Part-time, Type of Role, Sub-setting (would allow to determine who can shield)
      Team Size (Small teams may not be able to rotate and may work more frequently)

      Access to Information and Guidance
      Team Cohesion/ Teamwork (Not supported by the team may mean more exposed)
      Patient Demographics (eg. High proportion of Elderly that do not use technology/ minority ethnic/ socioeconomic background)

      Implemented Policy/guidance recs/own strategy and coping system
      Workload Changes (due to lack of support from Specialist Routine Services in Secondary Care not running), COVID cases

      Support (management, mental health, physical health, other)
      Team Demographics (Age, Sex, BAME, proportion who are in the Risk group)
      Training and Equipment (training provision how to stay safe, PPE)
      Staffing Levels Pre-Covid (if you are already short-staffed, you are less able to cope)
      Leadership and Communication
      Staffing Levels during Covid-19 outbreak
      Sickness Rate
      Patient Population (Patient demographics eg. Age, ethnicity, socio-economic etc)
      Leaving Rate
      Proportion of Temporary Staff/Locums
      Preparation

       

  6. Hi Michaela Will you be capturing data from different primary care models? There is a lot of variety in consultation pathways not just hot and cold hubs but also places of consultation and types of consultation. Does a clinicians practice change 'safety' level when in different settings even if the requirements for safe practice remain? A human factors issue to consider

    1. Thank you Elizabeth for your comment.

       

      These are exactly the kind of 'differences' that we would like to capture. If you look at the list of variables that we aim to collect ( the list is in my response to Ian's comments), it gives an idea. It is particularly useful to think about these differences when we are recruiting sites, in order to include a diverse group. Do you have any suggestions for how we might go about categorising 'places', types and settings?

       

      Best wishes

      Michaela

  7. Thank you Emma for your feedback! I will aim to connect with q members who are interested in these topics. Would you be able to provide any names of members/groups so that I can contact them?

     

    Best wishes

    Michaela

  8. Hi. I'm working with the Health Foundation to connect some of the Q Exchange proposals together & identify opportunities for member conversations. Your proposal sounds very clear and has obvious benefits for the development of safe practice for staff over the coming months. To gain some feedback and support for your proposal, you might want to consider approaching some of the online Q groups. We currently have one for primary care and a few for safety and staff well-being that might be helpful. Have a look on the community pages of this website. Best wishes, Emma

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