2. Methods

The project was split into 2 phases using qualitative and quantitative methods. Phase 1 of the study was exploratory and sought to identify salient topics relating to staff training needs, with particular interest on experiences of gathering patient information, navigatin g patient requests, and carrying out remote triage and consultations. Insights from this qualitative phase involving focus groups and semi-structured interviews were then used to inform Phase 2 through the development of a survey for general practice staff.

2.1 Phase 1: Qualitative research

Study design

Focus groups (n=8) and interviews (n=7) included a variety of clinical and non-clinical participants.

Recruitment

Recruitment to focus groups was publicised via a range of NHS channels, including email and social media; interested parties were allocated to a group and asked to fill out a consent form prior to participation. A full breakdown of how the research was publicised is available in Appendix A.

Data collection

31 staff took part in the qualitative phase, with representation from clinical (n=18) and non-clinical (n=13) roles. The non-clinicians were a broad group of support staff, including: practice managers, reception staff, and Clinical Commissioning Group (CCG) staff (n=13). The clinicians included GPs (n=9), pharmacists (n=5), and nurses (n=4).

The 8 focus groups took place between May 25, 2021, and July 15, 2021. Each focus group had between 2 and 6 participants, with 24 participants in total. The sample included representation from all regions of England as well as variations in practice types (urban, suburban, rural) and practice sizes. A breakdown of participant characteristics is available in Appendix B.

Seven interviews were carried out with participants unable to attend the focus groups, including support staff working in reception and the Clinical Commissioning Groups (CCG), as well as an assistant practice manager and a medical secretary (n=5), a pharmacist (n=1) and a GP (n=1).

Focus groups and interviews were carried out remotely and followed discussion guides that were broadly similar but varied in detail according to each role. The full discussion guides are available in the supplementary materials. The following topics were explored.

• How patient requests are handled, including the tools used (online consultation systems, templates, and protocols).
• Whether administrative/reception staff have a process or set of questions for identifying minor ailments/potentially urgent clinical problems.
• The level of confidence administrative/reception staff have when making decisions about patient requests and how they deal with low confidence.
• What sort of training might help administrative/reception staff to improve the process of gathering patient information and navigation patient requests.

Consent was taken from all focus group and interview participants prior to participation.

Data analysis

Focus group discussions and interviews were transcribed and anonymised prior to thematic analysis. Broad themes pertaining to non-clinical staff experiences of gathering patient information and navigating patient requests as well as clinical staff experiences of carrying out triage and remote consultations were drawn..

2.2 Phase 2: Quantitative research

Study design

Drawing on insights from Phase 1, an online survey was developed to gather information from a larger range of clinical and non-clinical staff.

Recruitment 

The survey was distributed via the same channels used to recruit for the qualitative phase and ran from January 18, 2022 to February 23, 2022.

Data collection

There were 791 consenting respondents in total; 417 were clinical staff, and 374 were non-clinical staff. Additional respondent characteristics (including role, location, and practice size) can be found in Section 4.1. A copy of the survey questions can be found in the supplementary materials.

Regardless of role, respondents were asked the following:

• number of hours of study or training they and completed over the last 12 months
• percentage of study or training that was carried out in protected time
• barriers to completing study or training experienced
• useful training topics and preferred method of training delivery

Branching logic was then used to split respondents between clinical and non-clinical roles. Non-clinical staff were asked about the following:

• levels of confidence when completing a range of tasks related to gathering patient information and navigating patient requests (including, where relevant, tasks relating to supervising and training colleagues to do the same)
• aspects of their role they found challenging
• details of training they had received in the last 12 months

Clinical staff were asked about the following:

• levels of confidence when carrying out triage
• any training pertaining to triage they had received
• any aspects of carrying out triage they find challenging
• for clinicians who carry out remote consultations: the proportion of weekly consultations carried out in different modality types (for example, phone, video, written messaging)
• aspects of remote consultations they found challenging

Consent was taken from all survey respondents. All responses were anonymous; the survey did not collect any personal and identifiable data. Details about data protection and consent can be found in the supplementary materials.

Data analysis

Raw data were downloaded from the online survey platform in comma-separated values (CSV) format. It was then cleaned and manipulated for analysis in Microsoft Excel.