The challenges of undertaking research at the Deep End are significant:
- It may take generations to have an impact on premature mortality rates and disease incidence and prevalence
- Deep End GPs are some of the the busiest clinicians with the ‘hardest to reach’ patients, making it difficult to recruit for studies
- The issues comprise complex problems in the ‘swampy lowlands’ of general practice – not nice neat RCTs about hypertension
- Time, ethics & governance: tension between clinical & academic world, need a clear research question
We should take inspiration from other work (i.e. Glasgow Deep End Group) and publications concerning interventions such as the social prescribing, work around health literacy and organisation of health care and equity, potentially replicating these in Yorkshire and Humber.
Aside from this, there are many examples of innovative work being undertaken by clinicians that are not recognised in the academic literature. A function of the academics in the group could be to help with evaluation, dissemination of ideas and economic assessment to underpin continued successful schemes.
Research and evaluation topics identified by Deep End GPs
Yorkshire and Humber Deep End GPs had these ideas for research and evaluation at the Deep End:
1) Disseminating details of deep-end relevant research in a brief and accessible manner
2) Guidance on managing venous thromboembolism and risk in intravenous drug users
3) Evaluation work:
- Integrated team working (i.e. Sheffield Pilot) – does it improve patient care?
- Interpreting services – how to you assess quality and effectiveness?
- Methods of reducing unregistered population – what works?
- Interventions to increase health literacy – what works?
- Social prescribing – does it improve health and wellbeing? Does it reduce hospital admissions / use of GP time?
- Cost and effectiveness of changing the skill mix (i.e. benefits, disbenefits and costs of using ANPs, PAs, pharmacists and other new entrants to the primary care workforce)
- What interventions most effectively influence the uptake of screening?
- Measures to reduce DNA rates – what works best (text messages, appointment cards etc)?
4) Develop specific KPIs for Deep End GP
5) Homelessness and learning disability – is there a link?
6) Barriers to access – what are they? How can they be removed?
7) What are the barriers to improved self-care in deprived or socially excluded populations?
8) Training capacity in areas of deprivation – what is the current situation and what is the projected increase / decrease due to recruitment and retention of GP trainers?
9)Reducing burnout in deep end GPs – what works?
10) What are the reasons for prison morbidity and mortality being so much higher than comparable non-prison population
11) What patient factors (i.e. language barriers, health literacy etc) and organisational factors (i.e. Nomad, written information, text messaging etc) most influence compliance with treatment in Deep End settings?
RESEARCH: immediate action identified by GPs
- Investigate barriers to self-care – what are they? How can they be addressed?
- Establish whether new roles within primary care skill mix are clinically effective and cost effective and describe the training needs for new healthcare professionals supporting GPs in areas of high deprivation
- Compile and share a synopsis of research relevant to Deep End GP