Inclusion Health Action in General Practice (IHAGP): evaluation

Appendix C: Staff Interview Discussion Guide

Introductions – About you and your practice

Interviews: we’ll start with some introductions. Can you please tell me a bit about your role at the practice and what it involves?

• All: what has been your role in the IHAGP programme and activity that has been delivered?
  • Probe: how did you come to be involved in the programme?
• Which IHAGP themes has your practice worked on?
  • (n.b. these are - theme 1: patient engagement, theme 2: workforce knowledge and skills, theme 3: proactive outreach / extended consultations)

Impact of IHAGP programme on service delivery and patient interactions – Patient engagement

(Theme 1: patient engagement):

• Can you briefly describe the patient engagement activities that your practice has offered through IHAGP?
  • Probe: health or wellbeing groups, peer support groups or patient panels, targeted patient feedback or engagement exercises, involvement of link workers or voluntary/community partners, Other
• How would you describe the uptake of these activities?
  • Probe: how well have patients engaged in these activities?
  • Probe: has there been any variation or patterns in the types of patient groups/communities engaging?
• Have you noticed any changes in those patients who have participated in these activities?
  • If yes: what changes have you observed?
  • If no: why do you think that is?
• What impacts have these activities had on staff?
  • Probe: workload pressure, understanding, satisfaction, collaboration, community connection?
  • Probe: in the short-term and long-term?
  • Probe: have these been largely positive or negative?
  • Probe for examples
• What impacts have these activities had on the practice as a whole?
  • Probe: in the short-term and long-term?
  • Probe: have these been largely positive or negative? Probe for examples
• And what support would help you sustain IHAGP activities?
  • Probe: non-funding support?

Impact of IHAGP programme on service delivery and patient interactions – Proactive outreach and/or Extended consultations

(Theme 3: enabling proactive outreach or extended consultations with patients at high risk)

• Can you briefly describe the efforts of your practice in terms of enabling proactive outreach with patients?
  • Probe: proactive patient call-outs or contact, targeted reviews for patients with high need, home visits or community-based clinics
• How did your practice identify the patients to reach out to?
  • Probe: did any particular factors come into consideration?
• Were there any challenges in identifying the patients to reach out to?
  • Probe: lack of clear tracking systems, inconsistencies, lack of time
• How have the patients who your practice is reaching out to engaged?
  • Probe: how have they responded?
• Have you noticed any changes or patterns for patients as a result of this proactive outreach?
  • If yes: what changes have you observed? (e.g. uptake of appointments, screening, improved outcomes)
  • If no: why do you think that is?
  • Prompt: do you think you would carry on with these changes even without ihagp funding?
• What impacts has this proactive outreach had on staff?
  • Probe: workload pressure, understanding, satisfaction, collaboration?
  • Probe: in the short-term and long-term?
  • Probe: have these been largely positive or negative?
  • Probe for examples
• What impacts has proactive outreach had on the practice as a whole?
  • Probe: impact on how the practice deals with missed appointments/screenings?
  • Probe: in the short-term and long-term?
  • Probe: have these been largely positive or negative? Probe for examples
• And what support would help you sustain IHAGP activities?
  • Probe: non-funding support?
• Extended consultations also fall under this theme. Can you briefly describe the efforts of your practice in terms of enabling extended consultations for complex patients?
• How have you found the delivery of these extended consultations?
  • Prompt: has anything supported this delivery? If yes, what?
  • Prompt: have there been any challenges? If yes, what?
  • Probe for positive/negative reactions – availability of cover, impact on patient experience, time needed for extended consultations, wider impact on workday/workload.
• How do you think patients feel about these extended consultations?
  • Probe: have you had any feedback from patients who have been given extended consultations? What do they say?
• What impacts has extended consultations had on staff?
  • Probe: workload pressure, understanding, satisfaction, collaboration?
  • Probe: in the short-term and long-term?
  • Probe: have these been largely positive or negative?
  • Probe for examples
• What impacts has extended consultations had on the practice as a whole?
  • Probe: impact on how the practice deals with patients who need more time?
  • Probe: in the short-term and long-term?
  • Probe: have these been largely positive or negative? Probe for examples
• And what support would help you sustain these activities?
  • Probe: non-funding support?

Perspectives on workforce training under IHAGP

(Theme 2: enhancing workforce knowledge and skills)

• Did your practice undertake any training or development under the IHAGP programme?
  • [E.g. mental health, trauma-informed care, inclusion health/working with vulnerable groups, communication skills or cultural awareness]
• Why did your practice choose this specific training/development?
• What form of training/development was this?
  • Probe: all-day/half-day? Online? In-person? Hybrid?
• How many staff in your practice undertook this training/development?
  • Probe: what staff took part? Where there any variations in terms of professions/level of seniority etc
• Did you personally take part in any training or development under the IHAGP programme?
  • If yes:
  • What did you take part in?
  • Did you find it useful?
  • What learning did you take from it?
• Have you applied this learning/your new skills in your daily work?
  • If yes:
  • How so? What has supported the use of this learning in your daily work?
  • If no:
  • Why not? What has limited the use of this learning in your daily work?
• What impacts has this learning and development had on the practice as a whole?
  • Probe: impact on how the practice deals with patients?
  • Probe: impact on the level of multidisciplinary working (i.e., some professions you work with more than you did previously)?
  • Probe: in the short-term and long-term?
  • Probe: have these been largely positive or negative?
  • Probe for examples

Remaining barriers for patients in accessing care – and suggestions for improvement

• Thinking more generally, what do you see as the key barriers for patients in accessing your GP services?
  • [E.g. registration, booking process, GP preference, getting to/attending appointments, interpreters]
  • Prompt: is there anything that makes it particularly difficult?
• What else do you think could improve patient access to your GP services?
  • Probe for suggestions

Reflections on whether IHAGP changes are sustainable in the long-term

• Has delivering IHAGP had an impact on staff wellbeing and morale?
  • If yes: what kind of an impact – positive or negative? Probe for examples
  • If no/limited impact: why do you think this is?
• And how has delivering IHAGP impacted staff workload?
  • Probe for examples
• What has been the main learning overall for you from your involvement in the IHAGP programme?
• Have there been any unexpected or unintended outcomes from the IHAGP programme?
  • If yes: what are these?
  • Note if positive or negative outcomes
• Would you say that IHAGP activities are integrated into routine practice at your GP practice now?
  • Probe: what would help you sustain or expand this work?
• Do you think the changes from IHAGP are sustainable without further funding?
  • Probe: why/why not?
  • [N.B. Are they embedded into practices or would they stop without funding]