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 Jeffries, Qualitative Researcher, Newcastle University

The MINDED pilot is being independently evaluated by researchers at Newcastle and Keele Universities, who are exploring the feasibility and acceptability, for patients and professionals working in general practice, of embedding a psychology team into general practice. The two-year programme of research is co-funded by the NIHR 3 Schools Mental Health Practice Evaluation Scheme and the NENC Deep End Network. Data collection for the pilot evaluation is currently underway at four GP practices in the NENC Deep End, including 3 waves of recruitment:

  • Recruitment wave 1: professionals working in general practice (Sept 2022 – Mar 2023). Focusing on time to build relationships and trust with key contacts in each practice, to conduct qualitative interviews of up to one hour via an online platform with GPs, psychology team, nurses, managers, PCN worker/s, front desk, telephone support etc, which will vary depending on the practice structure. Interviews n = 22.
  • Recruitment wave 2: patients registered at Deep End practices (Jan 2023 – present). Focusing on patient recruitment that is timely and utilises Clinical Research Network Primary Care Nurse’s role supporting recruitment on site. Study Information Packs and Consent Forms are distributed to eligible patients. Interviews n = 9.
  • Recruitment wave 3: systems partners (Oct 2023 – present). Focusing on professional interviews with people working in the wider health care system, including commissioning and health inequalities. Interviews n = 1.

The aim of the interviews is to i) explore the challenges and opportunities of recruiting, training and supporting new staff (the newly embedded psychology team); ii) understand the changes that take place in the workplace to support the introduction of the MINDED intervention; iii) document patients’ experiences and opinions of the intervention; iv) review professionals’ perspectives of the wider mental health care landscape in the region; and v) provide valuable learning for GPs interested in expanding their practice team.

The MINDED study will evaluate different models of service delivery, reflecting on the planning, delivery and outcomes of the intervention in different settings.

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

Exploring how routine practice communications can support health and digital literacy in Deep End NENC

Ms Alison Janes, Public Health Registrar

General practice use of text messages to communicate with patients has increased in recent years. Quantitative and qualitative studies suggest that despite widespread mobile phone use, digital literacy barriers to using text messages are common among populations with low health literacy. Socioeconomic deprivation is associated with lower levels of health literacy and higher levels of digital exclusion, which compound existing health inequalities among those living in deprived areas.

Working closely with one of our NENC Deep End general practices and local community organisations, this project explored public views on routine text message communications sent out from general practice. Focus groups will drew on examples of routine text message communications to explore how text messages are received and interpreted by individuals attending local community venues. Work to share findings is ongoing, to inform how text message templates can be developed to support NENC Deep End patients considering context, health literacy and digital inclusion.


TRAINDEEP (TRaining Assistance INitiative in DEep End Practices) pilot evaluation: transforming GP practices into training practices in deprived areas of the North East and North Cumbria region of England

Research contact: Dr Alisha Gupta, Academic Foundation Doctor, Population Health Sciences Institute, Newcastle University

GP training disproportionately takes place in affluent areas; therefore, GP trainees lack experience of working in deprived areas and the additional challenges posed with this. GPs working in deprived communities serve larger patient populations with grater healthcare needs than those in affluent areas. GP trainees tend to stay in areas they have trained in, which further exacerbates the healthcare disparities.

The primary aim of this research study is to evaluate the implementation of this intervention; understanding the views and experiences (including opportunities and challenges) of delivering this pilot in the context of high deprivation. The intervention aims to turn a non-training practice into a training practice, which will ultimately increase the number of training places and opportunities available to GP trainees in areas of high socioeconomic deprivation.

Qualitative interviews will explore the opinions of those involved in implementing the pilot, to find out their views and recommendations for improvement.

Immunisation at the Deep End

Primary Researcher: Amber Sacre, PhD Student, Newcastle University, Population Health Sciences Institute

A qualitative study examining the challenges of delivering the 0-5 childhood immunisation programme in areas with high levels of deprivation in the North East and North Cumbria.  Semi-structured interviews will explore the opinions of the intervention pilot aimed at relieving the burden of delivery on GP practices in the NENC Deep End Network (see below for more details). The perspectives of various individuals involved in the childhood immunisation will be sought, including nurses, general practitioners, admin staff, and other key individuals involved in delivering the childhood immunisations programme from the wider health and care system.

The Immunisation Pilot

It is recognised that Deep End Practices face specific challenges when delivering the 0-5 childhood immunisation programme. Often, a significant amount of staff time and effort is required to vaccinate hard-to-reach groups, and subsequently, meet QOF uptake targets. The aim of the pilot, therefore, is to relieve some of the burden by offering practices with the lowest uptake in the Deep End a chance for an immunisation catch-up team to provide support for a period of up to two weeks. The team will consist of two nursing staff, and it will be up to the discretion of each individual practice as to what tasks will be of most benefit. Nevertheless, it is expected that this may include, contacting parents/caregivers to arrange immunisation appointments, and/or vaccinating children by holding additional immunisation clinics, or offering home visits to identified individuals.

The Social Determinates of Health Workers (SDHW) Pilot

Dr Jen Portice,

This research investigates the impact of SDHW in the Deep End. We are currently working through an initial co-design process. This involves talking to those who work in the Deep End about their experiences with similar initiatives (e.g. link workers), the gaps and needs of the communities they serve and how they would like to see the impact (both practically and how to measure this). In addition, the researcher(s) will be present at webinars and group meetings, collecting ethnographic data covering the same area as the interviews.

This will contribute to clarifying what the different surgeries want and need in terms of SDHW. For some surgeries, this may be in adding additional link workers; for others, it may be interventions for specific patient groups whose health and well-being could benefit from social interventions. For others still, it may be introducing legal rights clinic or benefits advice as part of the offer in the GP surgery.

As researchers, we will further evaluate the pilot with interviews of staff (and potentially patients) once the intervention has started. In addition to other measures that may be added as part of the discussions with those working in the Deep End (e.g. quantitative measures, ethnographic data, etc.).


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.