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

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Because COVID-19 is so contagious, the way the NHS works has changed dramatically. For the first time since 1948, youcan't walk into a GP surgery and ask to be seen. You must apply online, phone the surgery or contact NHS111. You maythen 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 ofwhat it is to care and be cared for, and what 'good' and 'excellent' health services look and feel like. Will the doctor be ableto assess you properly by video or phone?We are an interdisciplinary team specialising in the study of complex, technology-supported change in health and caresettings. 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 ittogether and support its rapid use;- Using collaborative improvement techniques, strengthen the supporting infrastructure for digital innovation in the NHS.