GPs at the Deep End North East North Cumbria

Co-designing the Deep End NENC

Our first project has been co-designing the Deep End network. Co-design is the process of creating a grassroots-led network which will hopefully be relevant and sustainable. Our research team conducted a series of interviews with GPs, nurses, and social prescribing link workers from all over the region to find out the challenges in their day to day working lives, and what they would want a Deep End network to offer.

Read our initial report.

COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

We know that the COVID-19 pandemic disproportionately affected those living in areas of high socioeconomic deprivation. In this paper we gather the experiences of fifteen Deep End staff during the second wave of COVID-19 and consider the reasons why this might be, and how it can be avoided in the future.

You can read ‘COVID-19 at the Deep End’ in the International Journal of Environmental Research and Public Health for free here.

Mental health IN the Deep EnD (MINDED) pilot evaluation: Embedding new models of mental health care in primary care

Research contact: Dr Jayne Jefferies, Post-doctoral Qualitative Researcher, Newcastle University

The MINDED pilot evaluation is being led together by the Deep End Network and researchers at Newcastle University in the Population Health Sciences Institute. The two year programme of research (funded by the NIHR Mental Health Practice evaluation scheme) will evaluate the intervention by exploring the feasibility and acceptability, for patients, GPs and primary care staff, of embedding a psychology team into general practice. Data collection for the pilot evaluation is currently underway at four GP practices in the NENC Deep End, and will take place in different stages.

In stage 1 (Sept 2022 – Mar 2023) we will focus on the recruitment of primary care staff, including time to build relationships and trust with key contacts within each practice. Qualitative interviews of up to one hour via an online platform with GPs, clinical psychology team, nurses, practice manager, PCN worker/s, front desk, telephone support etc will vary depending on the practice structure. Eight interviews have been conducted to date (Nov 2022).

In stage 2 (Jan – July 2023) we will focus on the recruitment of patients via Participant Identification Centres (PICs), an agreement with DE practices to identify patients for interview/s. A recruitment video (see PPI update) will be displayed in practices and a Study Information Pack will be distributed to patients, inviting them to take part in the evaluation. We will conduct 16 patient interviews (4 in each practice).

In stage 3 (Apr – Oct 2023) we will focus on the recruitment of professionals in the wider local health care system.

Interviews will:

  • explore the challenges and opportunities of recruiting, training and supporting new staff (the newly embedded psychology team);
  • examine the protocols and procedures that develop to support the introduction of the MINDED intervention;
  • document patients’ experiences and opinions of the intervention;
  • review professionals’ perspectives of the wider mental health care landscape in the region; and provide valuable learning for GPs interested in expanding their practice team.

The pilot will provide discrete case studies of the planning, delivery and outcomes of the intervention in different places, which together offer a unique methodological take on the evaluation of complex interventions.

You can watch a video about the MINDED evaluation here.

Evaluating an NENC Deep End pilot intervention – TAPER research project

Research contact: Dr Charlotte Parbery-Clark, Public Health Registrar, Newcastle University

Deep End ProjecT: PrimAry care Professionals’ Experience of Reducing opioid and gabapentinoid prescribing in socioeconomically disadvantaged communities in the North East of England (TAPER).

It is recognised locally that many Deep End practices have high prescription rates of opioid and gabapentinoids which are correlated with deprivation. The Deep End North East and North Cumbria (NENC) Network is supporting the delivery of a six-month pilot to reduce opioid and gabapentinoid prescription rates in patients identified as high risk by implementing medication reviews and other allied work in six Deep End GP practices.

This pilot qualitative evaluation is an adjunct to the small-scale services evaluation. This qualitative evaluation will explore primary care professionals’ views and experiences of the planned medication reviews and allied work to reduce opioid and gabapentinoid prescribing in high-risk patients. This will include exploration of potential barriers and/or facilitators of the work. This qualitative evaluation draws on a hybrid blended pragmatic model, using ethnographic approaches, to allow for multiple angles from which to ‘view’ the work undertaken. A dual approach is being taken with observations at relevant meetings as well as semi-structured interviews of staff involved in the work in each of the six practices.

Undertaking this qualitative evaluation is important as the existing evidence-based around such interventions is limited. This qualitative evaluation will help to inform future developments in primary care to address health and care inequalities by making evidence-based recommendations about further development and implementation of these and allied future work.

Research activity informing action to increase recruitment of GPs to work in the Deep End

Research contact: Dr Matthew Armstrong, Deep End GP, Cruddas Park Surgery, Newcastle upon Tyne

 The difficulty of recruiting general practitioners to work in Deep End practices is a well-documented problem.  This qualitative study used a thematic analysis to assess the perceptions and experiences of general practice trainees of working in Deep End or deprived area practices and explored how recruitment could be improved.  The study found there was a general lack of knowledge of the Deep End concept amongst trainee GPs, even in those who had worked in a Deep End practice.  Participants highlighted the challenges of working in areas of deprivation including the clinical challenges of the patient population such as drug and alcohol misuse.  However organisational challenges, such as the difficulty in managing complex patients in 10-minute appointments, and personal challenges, such as increased stress, were also important. On the contrary, participants emphasized increased job satisfaction and good teamwork.  The level of deprivation of the patient population itself was not a deterring factor for trainees.

Recommendations from the study that aim to improve recruitment to the Deep End included offering 15-minute appointments, having designated clinical professional development time and providing a mentoring programme with a senior clinician for support.  Such benefits should be highlighted clearly on any job adverts.  The importance of GP training in Deep End practices was also highlighted.  This not only equips trainees with the skills to deal with the clinical challenges of working in deprived areas but makes trainees much more likely to continue in the practice post training.  Thus the number of Deep End training practices should be increased to allow more trainees to have placements in the Deep End.  The Deep End concept should be taught in training to improve awareness and stimulate interest amongst trainees

Supporting greater health literary in Deep End NENC

Ms Alison Janes, North East Commissioning Support, Research & Evaluation co-ordinator

Working closely with one of our NENC Deep End general practices and individuals who currently experience low literacy, this project will explore examples of routine communications sent out from general practice, with the aim of developing resources to support greater health literacy.

Patient and Public Involvement and Engagement (PPIE) in NENC Deep End research

PPIE contact: Dr Angela Wearn, NENC ARC research fellow in public involvement and community engagement, Newcastle University

 In line with the ethos of ‘by the Deep End, for the Deep End’, the NENC Deep End team have begun to establish a strong thread of Patient and Public Involvement and Engagement (PPIE) throughout their research arm.  PPIE refers to patients and communities being actively involved, as partners, in shaping research design, process and outcomes. Embedding patient and public voice within the heart of our team will strengthen the relevance our activity, ensure patient experience is accurately represented and support our intentions to increase diversity within research participation.

To date, we have taken a multi-faceted approach to public involvement, working alongside both Deep End Practices and voluntary organisations; offering a mix of informal and longer-term opportunities for members of the public to contribute to the design and outcomes of our research projects. Over the coming months we aim to work collaboratively with our Local Clinical Research Network and other partners to expand capacity in this area and work towards the development of a regional Deep End public network.

The planned expansion of PPIE activity will also allow us to consider ‘what works’ within the NENC and develop and demonstrate inclusive approaches to partnership working across research, patients and practice.

Deep End Primary Care Research Activity and Engagement Review

Research contact: Ms Helen Riding, Research & Development manager, North of England Commissioning Support

This project is a partnership between the Research & Evidence team from North of England Commissioning Support (NECS), researchers from Newcastle University and the National Institute for Health and Care Research (NIHR) Local Clinical Research Network for the North East and North Cumbria (NENC). The evaluation aims to provide evidence-based recommendations as to how to increase engagement and delivery of NIHR portfolio research in areas of deprivation.

Quantitative analysis was carried out to understand existing levels of NIHR portfolio research activity in Deep End practices compared with other GP practices in the Local Clinical Research Network area of NENC. Results were compatible with lower levels of recruitment to portfolio studies in practices with the highest levels of blanket socioeconomic deprivation. These findings are informing next steps: an online survey and qualitative work with general practice staff working in areas of blanket and pocket deprivation to explore barriers and facilitators to research participation and delivery in more socioeconomically deprived communities.

Building and evidencing community asset partnerships in housing and health to address health disparities in North East North Cumbria

Research lead: Prof Monique Lhussier, Northumbria university

 Funding has been awarded by the UKRI AHRC from Nov 2022 for a 9 month project.  The aim if the research is to develop integrated ways of working, which embed community voices and assets into the work of third sector, statutory organisations and decision-making bodies to improve health and reduce disparities. Objectives include: to develop participatory methods to facilitate co-production with Experts by Experience (EbE);  to collate a database of evidence to inform decision making in policy, practice and research; building on existing practice, establish a physical integrated care hub; to develop a virtual directory of interventions and organisations in NENC, which, integrating data from the three previous objectives, will become a virtual consortium.  This project will purposefully seek to develop workable connections between the Deep End network and the organisations and initiatives highlighted in the directory.

Addressing healthcare and research inequalities: co-designing and evaluating CaPE clinics and novel recruitment strategies to achieve more equitable mental health research participation

Research lead: Dr Stuart Watson, Newcastle University

This mixed methods evaluation will explore the feasibility and acceptability, for patients and practitioners (primary care and secondary care doctors and allied health professionals), of CaPE clinics (which are offered preferentially to Deep End general practices) and research+me interventions to improve mental health patient care and research participation of disadvantaged groups. The research aims to:

  1. Co-design the CaPE clinic with patients and practitioners to effectively address the needs of disadvantaged patients groups in order to improve patient care and research participation.
  2. Explore with GPs’ and allied professionals willingness to refer and patients’ willingness to take up referrals to CaPE consultations
  3. Understand patient and GP experiences and opinions of the CaPE intervention
  4. Scope potential quantitative outcomes to inform a larger-scale evaluation of the impact of the provision of CaPE clinic model on patients’ mental health and wellbeing and research participation.
  5. Explore the feasibility, acceptability and use of research+me as a mechanism for improving recruitment into the ASCEnD study, and mental health research more generally, across disadvantaged groups.