Research on the design, delivery, impact and improvement of health services is a key strand of the Plymouth Institute of Health and Care Research’s work. Our expertise ranges from the evaluation of specific services, such as community-based mental health services, through to the current and future structure, distribution and funding of regional and national health provision. Other key areas of interest include the role that inequalities in healthcare provision play in overall health inequality, the delivery of non-clinical services, like social prescribing or dietetic interventions, and the adaptation of health services in the face of both short-term (e.g. Covid-19) and long-term challenges (e.g. the ageing population).
Adapting to Covid-19
The Covid-19 pandemic has posed multiple challenges to the provision of health services. Researchers in the Community and Primary Care Research Group have been undertaking a number of research projects in this area. Dr Sarah Rybczynska-Bunt and Professor Richard Byng have been leading the Plymouth site of the ESRC funded ‘Remote by Default’ Covid-19 project which examines digital communications between patients and primary care practices in light of the need to limit face-to-face appointments. Byng has also collaborated with other academics in the NIHR ARC South West Peninsula (PenARC), and the Peninsula Clinical Trials Unit (PenCTU) to support the rapid reorganisation of General Practice in response to Covid.
Led by Professor Jenny Freeman, staff from the University’s Rehabilitation group and Centre for Health Technology, have developed a toolkit for health and social care practitioners, patients and carers to support the delivery of rehabilitation services via remote methods such as video-based and telephone. The Telerehab project, which is funded by NIHR and UKRI, responded to both the decline in face-to-face input during the Coid-019 period and the need to support those recovering from the disease.
Dietetics in Primary Care
part of the Dietetics, Human Nutrition and Health group, Professor Mary Hickson, Dr Avril
Collinson and Dr Jenny Child have explored new ways of working to manage
malnutrition and frailty and childhood allergy in GP surgeries. They have
also explored how dietitians can successfully take on a first contact
Health management and commissioning
Current and recent research projects including co-commissioning with third sector organisations, the Patient Safety Collaboration Evaluation Study and Integration and Continuity in Primary Care.
Inequalities in health care
There is debate regarding the role that inequalities in health care make to overall health inequalities, compared to disparities in sectors such as education, housing and income support. However, inequalities in the use of health care threaten the core NHS principle of health care equity (equal opportunity of access to health care for people with equal needs) and tend to conflict with the public’s understanding of what is ‘fair’. Our research looks at the role that health care inequalities plays in health inequalities, compared to sectors such as education, housing and income support.
Inequalities in the utilisation of cardiovascular care and mental health services have been an important focus of Asthana and Gibson’s research, in part through the use of the use of synthetic estimation techniques (within a Bayesian analytical framework) to develop prevalence estimates. This work has informed their research on formula funding for public services and a growing concern about the interlinked and complex problems driving service need in coastal areas.
As we can increasingly expect to interact with our health services through digital technologies, problems of digital exclusion (Asthana) are becoming an important focus of our research. The ‘Remote by Default’ Covid-19 project, funded through the ESRC, is examining digital communications between patients and primary care practices (and is led by Professor Trisha Greenhalgh from the University of Oxford). Working closely with ‘deep-end’ practices that service highly deprived populations, Rybczynska-Bunt and Byng are leading the Plymouth site which will focus on the impact of remote by default on individuals living in poverty or with complex needs.
With an ageing population, there is an increase in the number of people living with one or more long-term conditions; health and social care services are coming under increasing pressure. Rising and increasingly complex demand is forcing health and social care services to re-think and re-design the provision of service to assure good quality of care whilst ensuring services remains affordable.
Working with services in Torbay and South Devon, PIHR researchers (Byng, Elston, Gradinger, Asthana) have evaluated a range of innovations in integrated health and social care, from enhanced intermediate care services to the use of multi-disciplinary health and wellbeing teams. This work is part of a wider programme of research on Person Centred Coordinated Care, which has involved the development of frameworks to measure experiences and outcomes in multimorbid patients and organisational readiness for integration as well as carrying out a series of service evaluations (Lloyd).
People with schizophrenia and bipolar disorder often live very different lives from the general population, yet previous research suggests that many individuals with lower levels of need have minimal and poorly co-ordinated primary (GP) and secondary (specialist community mental health service) care. The NIHR funded Partners2 project aims to help primary care and community based mental health services work more closely together by developing a system of collaborative care based in GP surgeries for people with schizophrenia and bipolar disorder.
Researchers in the Community and Primary Care Research Group have been undertaking a range of studies examining community extension of primary and secondary health care services with a view to improving public health. This includes the NIHR’s Public Health Research Programme funded STRENGTHEN project, led by Professor Adrian Taylor which assessed whether additional support via Health Trainers was effective in improving the health behaviours and wellbeing of people receiving community supervision. Similarly the group also led the national study NIHR funded TARS study to investigate whether Health Trainer support was better at helping people quit smoking for longer, compared to existing support, while the e-coachER assessed the effectiveness of the GP Exercise Referral Scheme.
Led by Professor Jonathan Pinkney and Dr Dawn Swancutt, with co-applicants Dr Sarah Baldrey, Professor Adrian Taylor and Professor Richard Byng, the NIHR funded PROGROUP study is examining the evidence base for specialist multidisciplinary (‘Tier 3’) services for obesity, and specifically whether a group-based behavioural intervention can be an effective model of care for these services.
Further details can be found on the group’s public health webpage.
Social Prescribing is designed to support the non-clinical needs of people who may need support with their mental health, who are lonely or isolated and who have long-term conditions or complex social needs that affect their wellbeing. It tends to comprise both a pathway through which individuals experience services (including, for example, self-referral, a referrer and link worker) and a set of activities or interventions (e.g. nature-based, art based, debt and housing advice)
We have considerable research expertise in social prescribing and host the NIHR-funded academic collaborative for the National Academy for Social Prescribing (Husk, Elston, Carder-Glbert, Cartwright). Husk is currently leading on a project, funded by NIHR and MRC, in collaboration with the University of Sheffield, to investigate how social prescribing might be broadened and offered outside the NHS.
Supporting health system design
We have been working with our trust partners to support key developments in health system design including integrated care, the development of health hubs and the Health Infrastructure Plan (HIP2), now New Hospital Programme. As part of this we organised a series of online consultation sessions with academics and key regional stakeholders, from the NHS and industry. Read our rapid review of key issues for the future and our Green Paper, collating the consultation responses.
We have also engaged in futuristic research about what the health system of the future may look like in 2050; what role hospitals and ‘spoke’ hubs may play in the wide system and how can they best be designed for both sustainability and service quality (in terms of e.g. patient flow and therapeutic landscapes). Take a look at our entry for the Wolfson Economics Prize (the hospital of the future) to explore the interdisciplinary work we have been doing between experts in health policy (Sheena Asthana), architecture (Bob Brown) and primary care (Richard Byng) and medical and quality improvement staff from Torbay and South Devon Foundation Trust (Joanne Watson and Susan Martin). Thanks to architecture MA students Josh Earl, Chrisopher Trigg and Aaron Walkley for the great graphics.
As digital technology is expected to play an important role in the health service of the future, we carry our research reviews, work with digital producers, offer test-bed opportunities and evaluate a wide range of digital projects (Centre for Health Technology).
Internationally, we have supported the process of setting priorities for research that is responsive to the needs of health system. This includes a meta-research project that developed new frameworks that informed the work of the World Health Organisation, the Cochrane Priority Setting Methods Group (based at the University of Plymouth) and the EVIR funders forum (Nasser).
Community and Primary Care Research Group (CPCRG)
The Community and Primary Care Research Group (CPCRG) is intensively research active and has a strong proven track record of Health Services Research. Our research is conducted through the involvement of practitioners and the public, who are instrumental in helping to develop focused research questions and in designing projects.