PP4M
Research type
Research Study
Full title
Personalised Primary care for Patients with Multimorbidity (PP4M) – a primary care service improvement initiative
IRAS ID
303831
Contact name
Rachel Johnson
Contact email
Sponsor organisation
University of Bristol
ISRCTN Number
ISRCTN40295449
Duration of Study in the UK
1 years, 1 months, 0 days
Research summary
General practices regularly review patients with long-term health conditions included in the Quality & Outcomes Framework (QOF) using computerised templates (checklists) for each health condition. Reviewing each disease ‘one-at-a-time’ leads to fragmented care for people with multiple long term health conditions (MLTC) and can ignore conditions that are not included in QOF. These are sometimes the problems that bother patients most. Standardisation of care using checklists can improve safety but a priority in the NHS Plan is also to make care more personalised, and tailored to each individual.
Some practices have replaced separate disease-focused reviews with a combined annual review consultation for people with MLTC. A promising way to balance the benefits of templates with the need to personalise care is to use a ‘smart’ template focused on what matters most to patients, which supports self-management and shared decision-making. It includes links to social prescribing and pharmacist review of complicated medication, and involves agreeing a care and support plan. This concept has been shown to improve personalised care in a large research trial. In this project we will adapt a template already developed for MLTC and make it more personalised. We will make it widely available to general practices, supported with training and other tools e.g. to identify patients with multimorbidity, and to use patient questionnaires to gain feedback to improve the process. Working with primary care networks in three areas of England we will support implementation of this approach (whole-person review, template, training, tools). To reduce health inequalities, we will start with practices in deprived areas and patients with cardiovascular diseases alongside other conditions. In three practices in deprived areas of Bristol we will provide more in depth support and training, as part of developing a broader system change called ‘Maxwell’. We will conduct more detailed evaluation in this small sub-set of practices to understand whether the additional support and training is useful and what it adds to provision of the template alone.
Implementation will be informed by established theories that help explain how innovations are adopted into normal practice. Implementation will be evaluated using a range of methods including routinely collected activity and clinical data, questionnaires and interviews with patients and staff. This project will provide evidence to support and inform wide-spread implementation of a ‘whole-person’ review for patients with MLTC in line with the NHS Comprehensive Model for Personalised Care.REC name
Wales REC 6
REC reference
22/WA/0018
Date of REC Opinion
31 Jan 2022
REC opinion
Further Information Favourable Opinion