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Background The use of web-based services within primary care (PC) in the National Health Service in England is increasing, with medically underserved populations being less likely to engage with web-based services than other patient groups. Digital facilitation—referring to a range of processes, procedures, and personnel that seek to support patients in the uptake and use of web-based services—may be a way of addressing these challenges. However, the models and impact of digital facilitation currently in use are unclear. Objective This study aimed to identify, characterize, and differentiate between different approaches to digital facilitation in PC; establish what is known about the effectiveness of different approaches; and understand the enablers of digital facilitation. Methods Adopting scoping review methodology, we searched academic databases (PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library) and gray literature published between 2015 and 2020. We conducted snowball searches of reference lists of included articles and articles identified during screening as relevant to digital facilitation, but which did not meet the inclusion criteria because of article type restrictions. Titles and abstracts were independently screened by 2 reviewers. Data from eligible studies were analyzed using a narrative synthesis approach. Results A total of 85 publications were included. Most (71/85, 84%) were concerned with digital facilitation approaches targeted at patients (promotion of services, training patients to improve their technical skills, or other guidance and support). Further identified approaches targeted PC staff to help patients (eg, improving staff knowledge of web-based services and enhancing their technical or communication skills). Qualitative evidence suggests that some digital facilitation may be effective in promoting the uptake and use of web-based services by patients (eg, recommendation of web-based services by practice staff and coaching). We found little evidence that providing patients with initial assistance in registering for or accessing web-based services leads to increased long-term use. Few studies have addressed the effects of digital facilitation on health care inequalities. Those that addressed this suggested that providing technical training for patients could be effective, at least in part, in reducing inequalities, although not entirely. Factors affecting the success of digital facilitation include perceptions of the usefulness of the web-based service, trust in the service, patients’ trust in providers, the capacity of PC staff, guidelines or regulations supporting facilitation efforts, and staff buy-in and motivation. Conclusions Digital facilitation has the potential to increase the uptake and use of web-based services by PC patients. Understanding the approaches that are most effective and cost-effective, for whom, and under what circumstances requires further research, including rigorous evaluations of longer-term impacts. As efforts continue to increase the use of web-based services in PC in England and elsewhere, we offer an early typology to inform conceptual development and evaluations. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020189019; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019

ObjectivesPrimary care networks (PCNs) were introduced in the National Health Service (NHS) in England in 2019 to improve integrated care for patients and help address financial and workforce sustainability issues in general practice. The purpose of this study was to collect early evidence on their implementation and development, including motivations to participate and what enables or inhibits progress. This paper considers the core characteristics of PCNs, and how this informs their management.DesignA qualitative mixed-methods rapid evaluation was conducted across four case study sites in England, informed by a literature review and stakeholder workshop. Data collection comprised interviews, non-participant observation of meetings, an online survey and documentary review.ResultsGeneral practitioners (GPs) are motivated to participate in PCNs for their potential to improve patient care, enable better coordinated services and enhance financial and workforce sustainability within primary care. However, PCNs also have an almost mandatory feel, based on the national policy context and significant financial incentives associated with joining them. PCNs offer potential to bring GPs together to work towards common goals, deliver national priorities and respond rapidly to local needs.ConclusionsPCNs face similar challenges to other meso-level primary care organisations internationally, as they respond to local and national priorities and operate in a context of multiple goals and interests. In managing these organisations, it is important to find a balance between local and national autonomy, decision making and control.

Background: Point of care testing (POCT) for infectious diseases is testing conducted near the patient. It allows clinicians to offer the most appropriate treatment more quickly. As POCT devices have increased in accuracy and become more cost-effective, their use has grown, but a systematic assessment of their use for clinical and public health management of infectious diseases in EU/EEA countries has not been previously undertaken.Methods: A scoping review of the literature on POCT in EU/ EEA countries as at November 2019, and a survey of key stakeholders.Results: 350 relevant articles were identified and 54 survey responses from 26 EU/EEA countries were analysed. POCT is available for a range of infectious diseases and in all countries responding to the survey (for at least one disease). POCT is commonly available for influenza, HIV/AIDS, Legionnaires' disease and malaria, where it is used in at least half of EU/EEA countries. While POCT has the potential to support many improvements to clinical care of infectious diseases (e.g., faster diagnosis, more appropriate use of antimicrobials), the results suggest POCT is infrequently used to support public health functions (e.g., disease surveillance and reporting).Conclusion: Although POCT is in use to some extent in all EU/EEA countries, the full benefits of POCT in wider public health functions have yet to be realised. Further research on barriers and facilitators to implementation is warranted.

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Background: Mass asymptomatic COVID-19 testing programmes are being introduced in a range of settings, including in higher education institutions (HEIs). We aimed to produce an ethical framework to identify the range of ethical considerations relevant to HEI testing programmes and to support organisational decision-making. Methods: We conducted a mixed-method consultation (survey and semi-structured interviews) with students and staff at a case study university that was running a student testing programme. Survey data were analysed descriptively; data analysis for interviews was based on the Framework method. The findings of the consultation were combined with literature review, legal/ethical analysis and expert views to produce an ethical framework. Results: A total of 239 people took part in the consultation: 213 completed surveys (189 students, 24 staff) and 26 (16 students, 7 staff) participated in interviews. The survey identified clear support (99% of survey respondents) for the testing programme. Around two-thirds (62%) supported non-mandatory participation. Over half (54%) felt that the programme would need to be at least moderately effective to be acceptable. Over three-quarters (76%) felt the university had some responsibility to run a testing programme. Synthesis of consultation findings and further analysis identified nine areas of ethical consideration for HEIs looking to implement mass asymptomatic testing programmes: design and operation; goals; properties of the test; enabling isolation; choices about participation; benefits, harms and opportunity costs; responsibilities between students and institutions; privacy, confidentiality and data-sharing; and communication. The ethical framework includes recommendations in each of these areas, with illustrative examples of how they might be put into practice. Conclusions: By identifying ethical considerations relevant to university student testing programmes using analysis and consultation, the framework we developed has potential to facilitate deliberation about ethical aspects of such programmes, as well as informing decision-making about their introduction, design and delivery.

Background Primary care networks are groups of general practices brought together in July 2019 to hold shared budgets and develop new services in response to NHS England (now NHS England and Improvement) policy. This study examined the early implementation of primary care networks, especially what has helped or hindered progress, how they operate in relation to pre-existing collaborations and issues for rural networks. Objective To produce early evidence about the development of primary care networks to inform policy for their future development. Our research questions were to investigate (1) the contextual background of primary care networks; (2) the rationale for general practices to enter into collaborations; (3) the early learning from establishing primary care networks; (4) barriers to and facilitators of effective collaboration across general practices; and (5) the likely future progress of primary care networks in the English NHS, including in the light of COVID-19. Design A qualitative cross-comparative case study evaluation comprised four work packages: (1) a rapid evidence assessment; (2) a workshop with academics, policy experts and patient/public representatives; (3) interviews with stakeholders, observations of meetings, a survey and documentary analysis across four case study sites; and (4) analysis and synthesis of findings to develop recommendations for the next stage of the development of primary care networks. Results Primary care networks have been implemented in a timely manner and have established a range of new local health services. Previous general practice collaborations provide much-needed support in terms of management, leadership and infrastructure, although they can be a source of tension within networks where interests, goals and ways of working do not align. Reasons for collaborative working typically focus on the sustainability of primary care and a desire for better-integrated services, although those cited as the basis for joining primary care networks were mostly related to policy and financial incentives. Early evidence reveals operational success in establishing organisational structures, recruiting to new roles and providing services as required by the national specification. Effective management and leadership, particularly with respect to having a committed clinical director, and constructive relationships between primary care networks and clinical commissioning groups, are important in ensuring success. In rural areas there was some perceived lack of fit with aspects of the primary care network specification, alongside existing challenges of providing primary care to rural populations. Limitations Arranging and carrying out interviews proved difficult given the workload associated with implementing networks and wider time pressures. Following the onset of the COVID-19 pandemic, the team was unable to undertake planned face-to-face workshops to explore findings. Given that primary care networks were in their first year of operation at the time of this evaluation, we were cautious in drawing definitive conclusions. Conclusions Key lessons focus on increasing the engagement of general practices and wider primary care teams with networks; building leadership and management capacity to support networks in fulfilling their contractual obligations and meeting local health needs; and clarifying how primary care networks will operate in the post-COVID-19 health and social care system. Future work Future work could involve evaluating the impact and effectiveness of primary care networks using quantitative and qualitative measures; undertaking research in both rural and urban areas, exploring the extent to which this context is significant; examining the cost and effectiveness of sustaining and extending leadership and management support within primary care networks; and understanding the relationships between primary care networks and the wider health and care system. Study registration This study is registered as PROSPERO CRD42018110790. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care and Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 27. See the NIHR Journals Library website for further project information.