Remote-by-Default Care in the COVID-19 Pandemic: addressing the micro, meso-, and macro-level challenges of a radical new service model

Professor in Primary Care Research and PenARC Deputy Director Richard Byng is part of a new project funded by the Economic and Social Research Council through UKRI’s Ideas to Address COVID-19 call. The team led by Professor Trisha Greenhalgh from the University of Oxford, and also including researchers from the Nuffield Trust, has been awarded £750,000 for the study, Remote-by-Default Care in the COVID-19 Pandemic.

Richard, who is a practising GP in Plymouth alongside his other roles, will be leading investigation of the implementation and scale-up of ‘remote-by-default’ working, where patients can no longer automatically access face-to-face appointments, as a result of COVID-19 in Plymouth. 

The wider project is seeking to: develop tools to help clinicians assess people effectively by phone or video; support the change process through action research; and strengthen the supporting infrastructure for digital innovation in the NHS.

Research objectives: 

1. Validate and embed evidence-based tools for remote assessment and monitoring.

2. Support local implementation teams to overcome technical, operational and professional barriers and implement remote-by-default service models rapidly and at scale.

3. Generate and apply insights on how NHS infrastructure can better support – and be supported by – digital innovation in a time of crisis.

Research questions: 

1. How can technology support assessment and monitoring of patients at a distance?

2. How can we achieve rapid spread and scale up of remote-by-default models of primary care?

3. What insights can we glean from this time of crisis that will help build a more resilient NHS?

Outline methods:

1. Tools: Qualitative research to develop instruments followed by quantitative validation studies.

2. Implementation and scale-up: Four contrasting case studies in different localities, nested in an over-arching analysis of national policy. Action research (informed by interviews, ethnography, documents, datasets) by virtual researchers-in-residence.

3. Workshops and scenario-testing: Involving policymakers, regulators, professional bodies,industry, patients/citizens, to identify ways to strengthen infrastructure for rapid change.


1. At least two evidence-based assessment tools: qualitative (for remote assessment of key prognostic symptoms) and quantitative (a COVID-19-specific early warning score).

2. Transferable lessons about how to achieve rapid spread and scale-up, spread in real time through our extensive intersectoral networks.

3. Strengthened infrastructure for supporting digital innovation in the NHS.


Because COVID-19 is so contagious, the way the NHS works has changed dramatically. For the first time since 1948, you can’t walk into a GP surgery and ask to be seen. You must apply online, phone the surgery or contact NHS111. You may then get a call-back (phone or video) from a clinician, or a face-to-face appointment, possibly in a ‘hot hub’.

These changes to what used to be the family doctor service are radical, frightening and difficult.

They cut to the core of what it is to care and be cared for, and what ‘good’ and ‘excellent’ health services look and feel like. Will the doctor be able to assess you properly by video or phone?

We are an interdisciplinary team specialising in the study of complex, technology-supported change in health and care settings. Using a variety of methods, we want to do three things:

  • Develop tools to help clinicians assess people effectively by phone or video;
  • Support the change process through ‘action research’ – that is, working with GP teams to collect relevant data, analyse it together and support its rapid use;
  • Using collaborative improvement techniques, strengthen the supporting infrastructurefor digital innovation in the NHS.

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