Co‐Producing an Implementation Package for the Patient‐Directed Management of Post‐Discharge General Practice Care for Older Persons
Rachel Ann Spencer, Naomi Klepacz, Annabelle Long, Jeremy DaleABSTRACT
Background
Interdisciplinary working for the safety improvement of older patients’ care after discharge is complex. As part of the General Practice Management After Transitions Events (GP‐MATE) study, a consensus workshop was convened bringing together patients, carers, secondary and primary care clinicians to co‐produce and prioritise recommendations for how a patient‐directed post‐discharge communication tool for older people should be implemented in the NHS.
Methods
We conducted a day‐long, face‐to‐face consensus workshop involving 21 participants: 10 patients, carers and public representatives; 5 secondary care frailty leaders and 6 general practice leaders. Using Nominal Group Technique, in small groups participants generated statements based on pre‐identified key ‘tensions’ derived from the 4‐year GP‐MATE study. These were then combined and moderated by the wider group and rated for acceptability and feasibility using RAND/UCLA voting across two rounds; round 2 conducted online.
Results
Participants produced 52 statements; 35 were considered acceptable and feasible. The highest‑ranked emphasised patient autonomy, clarity of purpose, and involvement of community‑based professionals (including District Nursing and Urgent Community Response teams) to reach frail or housebound patients. Complete digitisation was the only statement rated inappropriate. The importance of distinguishing GP‐MATE from current ways of working was also prioritised.
Conclusion
The workshop generated a set of co‑produced, theory‑informed recommendations to guide a definitive trial of GP‑MATE and support wider implementation of patient‑held communication tools in post‑discharge care. The study also demonstrated that RAND/UCLA can be successfully adapted for co‑production with mixed Public and Patient Involvement (PPI) and professional groups.
Patient or Public Contribution
The GP‐MATE study was centred on Experience‐Based Co‐Design as a method for participatory action research. We began with a patient experience film featuring patients from general practice in the West‐Midlands. Our intervention was developed by three teams of older patients and carers of older persons and is reported in the US patient‐focused journal Patient Education and Counselling. In the workshop described in this paper, patients and their carers were brought to power by working in parity of numbers with hospital professionals in smaller breakout groups. Our three breakout groups were planned to be co‐facilitated by PPI‐E contributors (but on the day, only one was well enough to undertake this role). We also included a local Healthwatch lead among our participants.