Richard Byng

University of Plymouth | UoP · Institute of Translational and Stratified Medicine (ITSMED)

Background: The introduction of remote and digital forms of working in UK general practice has driven the development of new routines and working styles. Aim: To explore and theorise how new forms of work have affected general practice staff. Design and setting: Multi-site, qualitative case study in UK general practice. Method: Using longitudinal e...

Introduction In this viewpoint we highlight a gap in the literature relating to the involvement of professional stakeholders in healthcare evaluation research. Method Using the Dementia—PersonAlised Care Team (D‐PACT) project as an example, we illustrate how professional stakeholder work can serve various functions, from understanding commissionin...

Many with severe mental illnesses are underserved by disjointed service provision. PARTNERS aims to address this via collaborative care with recovery-based coaching. PARTNERS was evaluated in a randomised controlled trial. Understanding how intervention delivery compared to the model, why this was, and under what circumstances, aids interpretation...

Background This paper evaluates the introduction of ten Community Health and Well-being Workers (CHWW) in four pilot sites across Cornwall. The period evaluated was from the initial start in June 2022 until June 2023, covering the project setup and implementation across a range of Primary Care Networks (PCNs) and Voluntary sector partners (VSCO)....

Background Most feedback received by health services is positive. Our systematic scoping review mapped all available empirical evidence for how positive patient feedback creates healthcare change. Most included papers did not provide specific details on positive feedback characteristics. Objectives Describe positive feedback characteristics by (1)...

Background and aims Individuals living with severe mental illness such as schizophrenia and bipolar can have significant emotional, cognitive, physical and social challenges. Most people with severe mental illness in the United Kingdom do not receive specialist mental health care. Collaborative care is a system of support that combines clinical and...

Reflexivity’, as used by Margaret Archer, means creative self‐mastery that enables individuals to evaluate their social situation and act purposively within it. People with complex health and social needs may be less able to reflect on their predicament and act to address it. Reflexivity is imperative in complex and changing social situations. The...

Background This paper evaluates the introduction of ten Community Health and Well-being Workers (CHWW) in four pilot sites across Cornwall. The period evaluated was from the initial start in June 2022 until June 2023, covering the project setup and implementation across a range of Primary Care Networks (PCNs) and Voluntary sector partners (VSCO). M...

Background Recruiting individuals with dementia for clinical trials within primary care is complex, involving socio-cultural, psychological, geographical, and service-related factors. Phase 1 of the Dementia PersonAlised Care Team (D-PACT) study assessed the feasibility of evaluating a personalized dementia support intervention based in primary car...

Background Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents occur in remote encounters and how to prevent them. Setting and sample UK primary care. 95 safety incidents (complaints, settled indemnity claims and reports) involving remote interactions. Separately, 12 general practices followed 2021...

Engager is a complex, collaborative, but flexible intervention providing psychological and practical support to male prison leavers with sentences of two years or less. Engager was not shown to be effective from an evaluation of standard outcome measures, although full delivery of the intervention was also not achieved. The success of interventions...

Background Contemporary general practice includes many kinds of remote encounter. The rise in telephone, video and online modalities for triage and clinical care requires clinicians and support staff to be trained, both individually and as teams, but evidence-based competencies have not previously been produced for general practice. Aim To identif...

Background This paper explores the extent to which the implementation and evaluation of a collaborative care model of face-to-face service delivery for people with severe mental illness was viable during the first UK lockdown associated with COVID-19. The PARTNERS2 cluster randomised controlled trial and process evaluation were co-designed with ser...

Objective To evaluate the cost-effectiveness of specialist hospital discharge and intermediate care (support after discharge) services for people who are homeless in England. Methods We estimated the comparative cost and consequences of different types of specialist care provided by 17 homeless hospital discharge and intermediate care services. We...

Continuity is a long-established and fiercely-defended value in primary care. Traditional continuity, based on a one-to-one doctor-patient relationship, has declined in recent years. Contemporary general practice is organisationally and technically complex, with multiple staff roles and technologies supporting patient access (e.g. electronic and te...

Practitioner understanding of patients' preferences, wishes and needs is essential for personalised health care i.e., focusing on 'what matters' to people based on their individual life situation. To develop such an understanding, dementia practitioners need to use communication practices that help people share their experiences, preferences, and p...

Background Different dementia support roles exist but evidence is lacking on which aspects are best, for whom and in what circumstance, and on their associated costs and benefits. Phase 1 of the Dementia PersonAlised Care Team programme (D-PACT), developed a post-diagnostic primary care-based intervention for people with dementia and their carers a...

Background: Individuals living with severe mental illness can have significant emotional, physical and social challenges. Collaborative care combines clinical and organisational components. Aims: We tested whether a primary care-based collaborative care model (PARTNERS) would improve quality of life for people with diagnoses of schizophrenia, bi...

Background: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and...

There are long‐standing concerns that people experiencing homelessness may not recover well if left unsupported after a hospital stay. This study reports on a study investigating the cost‐effectiveness of three different ‘in patient care coordination and discharge planning’ configurations for adults experiencing homelessness who are discharged from...

Background Many male prison leavers have significant mental health problems. Prison leavers often have a history of trauma, ongoing substance misuse and housing insecurity. Only a minority of prison leavers receive mental health care on release from prison. Objectives The aim of the Engager research programme was to develop and evaluate a theory-...

Background Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m ² ). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for...

Background Tackling problematic polypharmacy requires tailoring the use of medicines to individual circumstances and may involve the process of deprescribing. Deprescribing can cause anxiety and concern for clinicians and patients. Tailoring medication decisions often entails beyond protocol decision-making, a complex process involving emotional an...

Background Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse. Aims This study aims to evaluate whether the Engager intervention improves mental health outcomes following release. Method The design is a parallel randomised superiority tria...

Background: Following a pandemic-driven shift to remote service provision, UK general practices offer telephone, video or online consultation options alongside face-to-face. This study explores practices’ varied experiences over time as they seek to establish remote forms of accessing and delivering care. Methods: This protocol is for a mixed-metho...

Background: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and...

Background ‘Engager’ is an innovative ‘through-the-gate’ complex care intervention for male prison-leavers with common mental health problems. In parallel to the randomised-controlled trial of Engager (Trial registration number: ISRCTN11707331), a set of process evaluation analyses were undertaken. This paper reports on the depth multiple case stud...

Background Tackling problematic polypharmacy requires tailoring the use of medicines to individual needs and circumstances. This may involve stopping medicines (deprescribing) but patients and clinicians report uncertainty on how best to do this. The TAILOR medication synthesis sought to help understand how best to support deprescribing in older pe...

Randomized Controlled Trials (RCT) are the “gold standard” for measuring the effectiveness of an intervention. However, they have their limitations and are especially complex in prison settings. Several systematic reviews have highlighted some of the issues, including, institutional constraints e.g., “lock-downs,” follow-ups, contamination of alloc...

Background: The Covid-19 pandemic-related rise in remote consulting raises questions about the nature and type of risks in remote general practice AIM: To develop an empirically-based and theory-informed taxonomy of risks associated with remote consultations. Design and setting: Qualitative sub-study of data selected from the wider datasets of t...

Depression is highly recurrent, even following successful pharmacological and/or psychological intervention. We aimed to develop clinical prediction models to inform adults with recurrent depression choosing between antidepressant medication (ADM) maintenance or switching to mindfulness-based cognitive therapy (MBCT). Using previously published dat...

Background People in prison experience a range of physical and mental health problems. Evaluating the effectiveness and efficiency of prison-based interventions presents a number of methodological challenges. We present a case study of an economic evaluation of a prison-based intervention (“Engager”) to address common mental health problems. Metho...

‘Dementia - Personalised Care Team’ (D-PACT) is a five-year NIHR funded programme, using realist methods to develop and evaluate a complex, person-centred intervention for people with dementia and their carers. During the early project stages, we engaged with multiple stakeholders, including people with dementia and their carers, to develop an init...

Introduction: Intermediate care (IC) was redesigned to manage more complex, older patients in the community, avoid admissions and facilitate earlier hospital discharge. The service was 'enhanced' by employing GPs, pharmacists and the voluntary sector to be part of a daily interdisciplinary team meeting, working alongside social workers and communi...

Background and purpose Adults lacking capacity are under-represented in research; therefore, the evidence-base surrounding their support needs is inferior compared to other populations. Involving this group in research is fraught with challenges, including researcher uncertainties about how to carry out capacity judgements. Whilst ethical guideline...

Background In 2013, 70% of people who were homeless on admission to hospital were discharged back to the street without having their care and support needs addressed. In response, the UK government provided funding for 52 new specialist homeless hospital discharge schemes. This study employed RAMESES II (Realist And Meta-narrative Evidence Synthese...

Judgemental rationality is infrequently referenced within discussions of Realist Evaluations. Judgemental rationality refers to researchers’ capacity to assess which, potential, meanings provide the most credible explanations. In evaluation work, rationale for analysis is provided, though rarely do we see how an evaluator made judgements between co...

Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work and new roles and workflows), economically (costs and benefits are unevenly distributed across the system), technically (excellent care needs dependable links and high-...

Background Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners (GPs) have the confidence and experience to appropriately review and adjust doses of antip...

Purpose People experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wick...

Background Current NHS policy encourages an integrated approach to provision of mental and physical care for individuals with long term mental health problems. The ‘PARTNERS2’ complex intervention is designed to support individuals with psychosis in a primary care setting. Aims The trial will evaluate the clinical and cost-effectiveness of the PAR...

Background Primary care trainees are traditionally taught to use a consultation model which focuses on eliciting the patients’ main reason for consulting “today”. As the number of patients with multi-morbidity increases, this approach is often inappropriate or unhelpful. Patients can be left without an understanding of their interacting health issu...

UK general practitioner (GP) trainees are taught a consultation model which elicits the patients' main reason for consulting 'today'. This approach will often miss important issues for the increasing number of patients with multimorbidity. We developed the SHERPA model as a person-centred biopsychosocial framework for consulting patients with multi...

Background There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. Aims This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthca...

Background People in the criminal justice system have complex needs but often do not make use of services outside of prison, in many cases due to poorly joined up working between health and criminal justice services. The ‘Engager’ programme aimed to develop a complex collaborative care intervention for people leaving prison with common mental healt...

Background: Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners have the confidence and experience to appropriately review and adjust doses of antipsycho...

Background Inpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission. Methods We conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual,...

Abstract Background: Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with with homelessness and substance misuse. Only a minority receive specialist mental health care, including on release from prison. Few theoretically informed interventions have been developed to address th...

Objective: Self-harm and suicide are important topics to discuss with people experiencing mental health conditions. This study explores how such discussions unfold in practice, and how their moral and practical repercussions manifest for patients and doctors. Methods: Conversation analysis (CA) was used to examine 20 recorded examples of doctors...

In the past decade there has been a rapid increase in gender diversity, particularly in children and young people, with referrals to specialist gender clinics rising. In this article, the evolving terminology around transgender health is considered and the role of psychiatry is explored now that this condition is no longer classified as a mental il...

Purpose This integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community hub within one locality of an Integrated Care Organisation contribute to complex, person-centred, co-ordinated care. Design/methodology/approach This is a naturalis...

We analyze the use of nine-item Patient Health Questionnaire (PHQ-9), an instrument that is widely used in diagnosing and determining the severity of depression. Using conversation analysis, we show how the doctor deploys the PHQ-9 in response to the patient’s doubts about whether she is depressed. Rather than relaying the PHQ-9 verbatim, the docto...

In resource-stretched emergency departments, people accompanying patients play key roles in patients’ care. This article presents analysis of the ways health professionals and accompanying persons talked about admission decisions and caring roles. The authors used an ethnographic case study design involving participant observation and semi-structur...

In resource-stretched emergency departments, people accompanying patients play key roles in patients’ care. This article presents analysis of the ways health professionals and accompanying persons talked about admission decisions and caring roles. The authors used an ethnographic case study design involving participant observation and semi-structur...

Background Involving patients, service users, carers and members of the public in research has been part of health policy and practice in the UK for the last 15 years. However, low‐income communities tend to remain marginalized from the co‐design and delivery of mental health research, perpetuating the potential for health inequalities. Greater und...

Major depressive disorder is highly recurrent over the lifespan, even following successful pharmacological and/or psychological intervention. Here we investigate whether predictive modeling can be used to optimize treatment recommendations, when choosing between continuing maintenance antidepressant medication (mADM) treatment or switching to Mindf...

Objectives: This study aimed to describe the recovery journeys of people with a history of recurrent depression who took part in a psychosocial programme designed to teach skills to prevent depressive relapse (mindfulness-based cognitive therapy (MBCT)), alongside maintenance antidepressant medication (ADM). Design: A qualitative study embedded...

Background: NICE guidelines for the management of emotional concerns in primary care emphasise the importance of communication and a trusting relationship, which is difficult to operationalise in practice. Current pressures in the NHS mean that it is important to understand care from a patient perspective. This study aimed to explore patients' exp...

Introduction: If integrated care approaches are to be properly adapted to local contexts, a better understanding is required of key determinants of implementation and how these might be appropriately supported. Purpose: This study applied the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to investigate factors influenci...

Purpose Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds. Managerial workarounds have seldom been analysed. This paper does so by extending and modifying existing knowledge of the causes and character of clinical and IT workar...

Background: In the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns. Objective: To update and synthesize literature on barriers and facilitators to GP-patient communication about emotional concerns in UK primary care. Design: Systematic review and qualitative synthesis. Method: We conducted...

Background Little is known about the effectiveness or cost-effectiveness of interventions, such as health trainer support, to improve the health and well-being of people recently released from prison or serving a community sentence, because of the challenges in recruiting participants and following them up. Objectives This pilot trial aimed to ass...

Background: Improving Access to Psychological Therapies (IAPT) constitutes a key element of England’s national mental health strategy. Accessing IAPT usually requires patients to self-refer on the advice of their GP. Little is known about how GPs perceive and communicate IAPT services with patients from low-income communities, nor how the notion of...

Background: Patient take-up and adherence to antidepressants and talking therapy is low. However, little is known about how GPs recommend these treatments and whether patients accept them. Aim: To examine how GPs recommend antidepressants and talking therapy, and how patients respond. Design & setting: A total of 52 recorded primary care consu...

Up to 40% of general practitioners (GP) consultations contain an emotional component. General practitioners (GPs) have to provide care with limited time and resources. This qualitative study aimed to explore how GPs care for patients experiencing emotional concerns within the constraints of busy clinical practice. Seven GPs participated in three fo...

Aim To evaluate the impact of ‘holistic’ link-workers on service users’ well-being, activation and frailty, and their use of health and social care services and the associated costs. Background UK policy is encouraging social prescribing (SP) as a means to improve well-being, self-care and reduce demand on the NHS and social services. However, the...