UK general practice service delivery research priorities: an adapted James Lind Alliance approach

Abstract

Background General practice is in a state of crisis in a number of countries. In the UK, a range of measures have been introduced to address the situation, including innovations such as practice networks, multidisciplinary roles, and digital technologies. However, identifying what still needs fixing could benefit from more evidence, particularly in relation to day-to-day service delivery. Aim To identify the general practice workforce’s top 10 research priorities to improve service delivery. Design and setting This priority-setting study used an adapted James Lind Alliance methodology and involved staff working in general practice across the UK. Method The study comprised four phases: an online qualitative survey issued to the general practice workforce (clinical and non-clinical groups); thematic analysis of free-text responses; generation of indicative research questions; and the undertaking of ranking exercises with responders of the original survey. An online workshop was held with participants at the final stage of prioritisation. Results In total, 93 staff completed a survey in Phase 1, from which 20 themes were categorised and developed into research questions. Twenty-two staff responded to the first ranking activity and 11 took part in a second ranking activity to discuss themes that had a tied vote. The final top 10 research priorities were: volume of work; patient behaviour; consultations; employment pay and conditions; workload dumping and care of patients on waiting list; funding; overwhelming pressure; patient health education; complex patient needs; and interfaces with secondary care. However, there was no clear ranking of these 10 priorities; instead, they carried equal weight and were closely interconnected. Conclusion Applying a marginal-gains approach, by seeking to explore all 10 priorities simultaneously as opposed to concentrating on one area at a time, may provide more noticeable improvements overall. Systems-based approaches that take account of the marked role that context has may be a particularly useful lens for future research.