Study title

Evaluating effectiveness, safety, patient experience and system implications of different models of using GPs in or alongside Emergency Departments (GPs in EDs)

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Principal / Lead Investigator

• Prof Adrian Edwards (PRIME, Cardiff University) 

Co-Investigators

• Prof Philippa Anderson (Swansea University),
• Prof Damon Berridge (Swansea University),
• Dr Andrew Carson-Stevens (PRIME, Cardiff University),
• Dr Alison Cooper (Cardiff University),
• Dr Michelle Edwards (Cardiff University),
• Prof Matthew Cooke (University of Warwick),
• Prof Jeremy Dale (University of Warwick),
• Dr Freya Davies (PRIME, Cardiff University),
• Prof Liam Donaldson (Imperial College, London)
• Dr Bridie Evans (PRIME, Swansea University),
• Barbara Harrington (public contributor),
• Julie Hepburn (public contributor), 
• Mr Peter Hibbert (Macquarie University, Australia)
• Dr Thomas Hughes (Oxford School of Emergency Medicine),
• Dr Alison Porter (PRIME, Swansea University),
• Prof Tim Rainer (Cardiff University),
• Prof Niro Siriwardena (University of Lincoln),
• Prof Helen Snooks (PRIME, Swansea University) ,
• Prof Alan Watkins (Swansea University).

Type of study

Realist evaluation using mixed methods

Who is the study sponsor?

Cardiff University

Summary 

Hospital emergency departments (EDs) are under increasing, sometimes extreme, pressure. Patients are experiencing long hours of waiting to be seen. We have seen media reports of emergency services in crisis. This situation has arisen partly because people attend EDs with problems that GPs could deal with. Finding better ways to assess and treat patients coming to EDs could have a major impact on the experience and care of the millions of people attending EDs and on all NHS services by providing evidence of how best to manage resources.

Many EDs now work closely with GPs in three main ways: 

• Assessing patients and sending them to a GP clinic next door to the ED;
• Placing GPs in the ED to make a brief assessment of patients and decide what type of healthcare provider they need to see
• Placing GPs in the ED as extra staff to provide treatment.           

It is not known how well these arrangements provide care or if they make a difference to how quickly patients receive treatment and referrals for tests and other services. Our study will look at what works, for whom and in what circumstances. 

In this study we will look at: 

1. What are the different ways of working, how are they are organised and how common are they?
2. How do they work in practice? Do they do what they were meant to do?
3. Hospital admissions, re-attendance, waiting times, patient safety and staff and patient satisfaction
4. What are the key factors that lead to a better service? 

Public / patient involvement

Two public collaborators recruited from the Involving People network are co-applicants for the project, and were actively involved in preparing the funding bid for the study. During the study, the public collaborators have been involved at an operational level, regularly attending co-applicant meetings, playing a key role in drafting patient-facing materials, reviewing patient recruitment methods, overseeing qualitative data analyses, planning and recruiting for stakeholder events and supporting public attendees.

Our public collaborators have produced lay summaries for all publication (below). You can view all lay summaries here.

How could this research potentially benefit patients?

Currently, the effectiveness of each GP-ED model is unclear in terms of its impact on service provision, patient experience and the effectiveness and safety of clinical care delivery. This study plans to address that research gap.

Does the study involve a methodological innovation?

The mixed methods design will use ‘realist evaluation’ to examine the effectiveness of the models in terms of what works, for whom and in what circumstances. 

Funder

Health Services and Delivery Research (HS&DR) Programme       

Total grant value

£ 954,863

Start date

01/03/2017

End date 

31/08/2021

Newsletter 

See our newsletter, containing links to all publications and lay summaries, here.

Outputs generated (Reports / Publications)

• Edwards A. HS&DR Project: 15/145/04 - A realist evaluation of effectiveness, safety, patient experience and system implications of different models of using GPs in or alongside Emergency Departments 2015. 

• Cooper A, Davies F, Edwards M, Anderson P, Cooke M, Donaldson L, Dale J, Evans BA, Hibbert P, Hughes T, Porter AM, Rainer T, Siriwardena N, Snooks HA, Edwards A. The impact of general practitioners working in or alongside emergency departments: a rapid realist review. View the lay summary here.
  
  
• Cooper A, Edwards M, Brandling J, Carson-Stevens A, Cooke M, Davies F, Hughes T, Morton K, Siriwardena N, Voss S, Banger J, Edwards A. Taxonomy of the form and function of primary care services in or alongside emergency departments: concepts paper. View the lay summary here.
  
  
• Hussain F, Cooper A, Carson-Stevens A, Donaldson L, Hibbert P, Hughes T, Edwards A. Diagnostic error in the emergency department: learning from national patient safety incident report analysis. View the lay summary here.
  
  
• Price D, Edwards M, Carson-Stevens A, Cooper A, Davies F, Evans BA, Hibbert P, Hughes T, Rainer T, Siriwardena N, Edwards A. Challenges of recruiting emergency department patients to a qualitative study: a thematic analysis of researchers' experiences. View the lay summary here.
  
  
• Cooper A, Carson-Stevens A, Hughes T, Edwards A. Is streaming patients in emergency departments to primary care services effective and safe? View the lay summary here.
  
  
• Edwards M, Cooper A, Davies F, et al. Emergency department clinical leads' experiences of implementing primary care services where GPs work in or alongside emergency departments in the UK: a qualitative study. View the lay summary here.

• Evans BA, Gallanders J, Griffiths L et al. Public involvement and engagement in primary and emergency care research: the story from PRIME Centre Wales. View the lay summary here.

• Edwards M, Cooper A, Davies F, Sherlock R, Hughes T, Carson-Stevens A, et al. A classification of primary care pathways in UK emergency departments: findings from a multi-methods study comprising cross-sectional survey; site visits with observations, semi-structured and informal interviews. View the lay summary here.

• Choudrhy M, Edwards M, Cooper A, Anderson P A, et al. Senior clinical and business managers’ perspectives on how different funding mechanisms and models of employing General Practitioners in or alongside Emergency Departments influence wider system outcomes: Qualitative Study. View the lay summary here.

• Cooper A, Carson-Stevens A, Edwards M, et al. Identifying safe care processes when GPs work in or alongside emergency departments: realist evaluation. View the lay summary here.

• Brant H, Voss S, Morton K, et al. Current provision of general practitioner services in or alongside Emergency Departments in England. View the lay summary here.

• Cooper A, Carson-Stevens A, Cooke M, et al. Learning from diagnostic error to improve patient safety when GPs work in or alongside emergency departments: incorporating realist methodology into patient safety incident report analysis. View the lay summary here.

• Price D, Edwards M, Davies F, et al. Patients' experiences of attending emergency departments where primary care services are located: qualitative findings from patient and clinician interviews from a realist evaluation. View the lay summary here.

• Edwards M, et al. The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety: a realist evaluation. View the lay summary here. 

• Evans BA, et al. Implementing public involvement throughout the research process - Experiences and learning from the GPs in EDs study. View the lay summary here.

Conference abstracts

• Primary care streaming in emergency departments and perceived mechanisms for effectiveness. SWSAPC, 2020.
• Senior clinical and business managers’ perspectives on how different funding mechanisms and models of employing GPs in or alongside EDs influence wider system outcomes. Qualitative Study. SWSAPC, 2020.
• A classification of primary care pathways in EDs: a multi-method study comprising cross-sectional survey; site visits with observations; semi-structured and informal interviews (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.
• Emergency department clinical leads' experiences of implementing primary care services where GPs work in or alongside emergency departments in the UK: a qualitative study (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.
• Patients' motivations and expectations when seeking urgent care at emergency departments and acceptability of primary care streaming: a realist study (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.
• Primary care streaming in emergency departments - contexts and mechanisms associated with perceived effectiveness outcomes: a realist evaluation (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.
• The role of GPs working in or alongside emergency departments and how this influences clinical decision-making: a realist synthesis and evaluation (poster). RCEM Virtual Scientific Conference, 13-14 October 2020.
• Exploring opportunities to improve patient safety where GPs work in or alongside emergency departments: a realist synthesis and evaluation (poster). RCEM Virtual Scientific Conference, 13-14 October 2020. 
• Challenges of recruiting emergency department patients to a qualitative study: a thematic analysis of researchers' experiences (poster). RCEM Virtual Scientific Conference, 13-14 October 2020.

• Embedding public involvement in a realist evaluation of GPs in Emergency Departments (poster). RCEM Virtual Scientific Conference, 13-14 October 2020.

Impact

To follow