A5044204354- Primary Care and Health Outcomes
- Healthcare Systems and Technology
- Healthcare Policy and Management
- Telemedicine and Telehealth Implementation
- Patient-Provider Communication in Healthcare
- Healthcare Quality and Management
- Chronic Disease Management Strategies
- Health Systems, Economic Evaluations, Quality of Life
- Global Health Workforce Issues
- Health Services Management and Policy
- Interprofessional Education and Collaboration
- Medical Malpractice and Liability Issues
- Healthcare cost, quality, practices
- Healthcare Systems and Challenges
- Geriatric Care and Nursing Homes
- Healthcare innovation and challenges
- Patient Satisfaction in Healthcare
- Assisted Reproductive Technology and Twin Pregnancy
- COVID-19 and healthcare impacts
- Child and Adolescent Health
- Emergency and Acute Care Studies
- Mental Health and Patient Involvement
- Patient Safety and Medication Errors
- Global Health Care Issues
- Medication Adherence and Compliance
Nuffield Trust
2013-2025
Nuffield Health
2025
University of Oxford
2025
University of California, San Diego
2021-2024
Queen Mary University of London
2023
UC San Diego Health System
2023
University of Greenwich
2017-2018
Leeds General Infirmary
2010
King's Fund
1999-2006
King's College School
2003
Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work new roles workflows), economically (costs benefits are unevenly distributed across the system), technically (excellent care needs dependable links high-quality audio images), relationally (interpersonal interactions altered), clinically (patients unique, some examinations require contact, clinicians have...
Fewer than 1% of UK general practice consultations occur by video.To explain why video are not more widely used in practice.Analysis a sub-sample data from three mixed-method case studies remote consultation services various settings 2019-2021.The dataset included interviews and focus groups with 121 participants primary care (33 patients, 55 GPs, 11 other clinicians, nine managers, four support staff, national policymakers, five technology industry). Data were transcribed, coded...
The COVID-19 pandemic-related rise in remote consulting raises questions about the nature and type of risks general practice.To develop an empirically based theory-informed taxonomy associated with consultations.Qualitative sub-study data selected from wider datasets three large, multi-site, mixed-method studies care practice before during pandemic UK.Semi-structured interviews focus groups, a total 176 clinicians 43 patients. Data were analysed thematically, taking account existing...
Background Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents in remote encounters how prevent them. Setting sample UK primary care. 95 (complaints, settled indemnity claims reports) involving interactions. Separately, 12 general practices followed 2021–2023. Methods Multimethod qualitative study. explored causes of real retrospectively (‘Safety I’ analysis). In a prospective longitudinal study, we used interviews ethnographic observation...
Background Contemporary general practice includes many kinds of remote encounter. The rise in telephone, video and online modalities for triage clinical care requires clinicians support staff to be trained, both individually as teams, but evidence-based competencies have not previously been produced practice. Aim To identify training needs, core competencies, learning methods providing encounters. Design setting Mixed-methods study UK Method Data were collated from longitudinal ethnographic...
Physicians of all specialties experienced unprecedented stressors during the COVID-19 pandemic, exacerbating preexisting burnout. We examine burnout's association with perceived and actionable electronic health record (EHR) workload factors personal, professional, organizational characteristics goal identifying levers that can be targeted to address
To access contemporary healthcare, patients must find and navigate a complex socio-technical network of human 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 large qualitative dataset from multi-site study remote technologies general practice to understand widening inequities access. We theorise our data by bringing together traditional candidacy theory...
Background and objectives AKI is an increasingly common devastating complication in hospitalized patients. Severe requiring RRT associated with in–hospital mortality rates exceeding 40%. Clinical decision making related to initiation for patients the medical intensive care unit not standardized. Design, setting, participants, & measurements We conducted a 13-month (November of 2013 December 2014) prospective cohort study academic involving implementation Standardized Assessment...
Requirements for physical distancing as a result of COVID-19 and the need to reduce risk infection prompted policy supporting rapid roll out video consulting across four nations UK-England, Northern Ireland, Scotland Wales. Drawing on three studies accelerated implementation uptake nations, we present comparative interpretive analysis spread scale-up during pandemic. Data include interviews with 59 national level stakeholders, 55 health social care staff 30 patients, 20 documents, responses...
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 establish forms of accessing and delivering care.This protocol is for mixed-methods multi-site case with co-design national stakeholder engagement. 11 were selected diversity in geographical location, size, demographics, ethos, digital maturity. Each practice...
Since 1991, there has been a series of reforms the English National Health Service (NHS) entailing an increasing separation between commissioners services and widening range public independent sector providers able to compete for contracts provide NHS patients. We examine extent which local had adopted market-oriented (transactional) model commissioning care people with long term conditions several years into latest period reform. The paper also considers factors that may have inhibited or...
Accessing and receiving care remotely (by telephone, video or online) became the default option during coronavirus disease 2019 (COVID-19) pandemic, but in-person has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote care, with recurrent waves of COVID-19 various post-pandemic backlogs.
Background: The introduction of remote and digital forms working in UK general practice has driven the development new routines styles. Aim: To explore theorise how work have affected staff. Design setting: Multi-site, qualitative case study practice. Method: Using longitudinal ethnography by researchers-in-residence, we followed 12 practices for 28 months (2021-2023). This core dataset was supplemented workshops stakeholder interviews. Data analysis applied theories from sociology...
Objective To examine the work of commissioning care for people with long-term conditions and factors inhibiting or facilitating commissioners making service change. Design Multisite mixed methods case study research, combining qualitative analysis interviews, documents observation meetings. Participants Primary trust managers clinicians, general practice-based commissioners, National Health Service foundation senior voluntary sector local government representatives. Setting Three...
This report discusses the proposal by Britain's coalition government to dramatically reform English National Health Service (NHS). The calls for a new capitated payment structure that would put general physicians in control of majority NHS budget.
Background Patient–physician communication during clinical encounters is essential to ensure quality of care. Many studies have attempted improve patient–physician communication. Incorporating patient priorities into agenda setting and medical decision-making are fundamental patient-centered Efficient scalable approaches needed empower patients speak up prepare physicians respond. Leveraging electronic health records (EHRs) in engaging care teams has the potential enhance integration...
Integrated care is central to current health reforms as policy makers and practitioners struggle address fragmentation of planning delivery. However, those pursuing integration have failed appreciate the complex nature fragmentation. We seek bring some much-needed clarity debate by considering a ‘wicked problem’ requiring locally driven multifaceted approach integration.
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National Health Service (NHS) walk-in centres offer immediate access to nurse-led primary care. Forty 'pilot' are now open, of which nine in London. In providing clinical assessment, health information and a limited range treatments users, they exemplify new nursing roles that emerging care.To describe the centre nurses, explore causes role stress review arrangements for training, development support. METHODS; Semi-structured interviews with 29 managers nurses from London 10 stakeholders...