London Strategic Research Health and Care Learning System

Uniting clinical and academic leaders across London to evaluate changes in care

During the first wave of the COVID-19 pandemic, health and care services had to quickly innovate and adapt to provide care and protect patients and staff, and to provide health services remotely. This created an urgent need to understand whether these major changes were positive or potentially harmful. However, no system was in place to support addressing this.

In response, The London Strategic Research Health and Care Learning System was established in June 2020 and had 3 key aims:

• Evaluation Priorities: Create a list of priorities, in the form of research proposals, detailing the most significant health and care changes caused by COVID-19 in London that need further evaluation, and to inform ongoing adoption and implementation of changes across the capital.
• Learning System: Develop a learning health system that allows service delivery to be informed by research findings, and the timely capture, analysis and feedback of clinical, service and outcomes data. This helps drive continual improvements to practice, that can be applied across larger populations.
• Collaboration: Between NHS England and applied health research partners to create long-lasting partnerships, underpinning the learning system approach.

The Partnership has led to development of a network of collaboration and knowledge sharing that did not previously exist, enabling clinical and academic health leaders to collectively identify and set evaluation priorities, with the aim of rapidly translating knowledge into service provision across the regional care sector.

The Partnership is a collaboration between the three London Academic Health Science Networks (AHSNs) and the three London NIHR Applied Research Collaborations (ARCs), working with the London regional NHS clinical and transformation leads, and chaired by an NHS Chief Executive.

The Partnership has agreed a set of criteria with regional clinical and academic leaders, including scale of impact, generalisability and measurability. These criteria have enabled us to collectively identify three priority areas for the London region, which require evaluation to inform future service design: remote consultations; remote blood pressure monitoring; and integrated palliative care.

Using these criteria, we led one of the first prioritised rapid evaluations of evidence on remote consultations in secondary care settings in COVID.  We are currently working with our Pan-London colleagues to design a second phase of work in this area, that will be used to directly inform how remote consultations are incorporated within routine healthcare delivery. 

Our rapid evaluation of remote consultations in secondary care settings found that:

Patient experiences

• For a proportion of patients (those currently able to access video consultations), video-consultation is a convenient form of consultation, and may be preferred, at least at this time
• Patients may have low levels of confidence regarding the use of video technology. A proportion (10%) require support with setting up the hardware and software
• Some patients may prefer telephone to video consultation and many would prefer at least some face-to-face consultations in the future.
• Aspects that improve patient experience of remote consultations include a pre-existing good relationship with the clinician, and help in dealing with technical issues.

Clinician experiences

• Among survey respondents, the majority (50-60%) consider video consultation to be ‘better’ than telephone while a minority (16%) considered a face-to-face consultation better. There is an appetite among some for remote consultations to play a role in future provision.
• Technical issues seem to have impeded experience in London. This may be a contributing factor to why the majority of consultations in most settings are done over the telephone

Organisational uptake

• Uptake of video consultations can vary within the same organisation. Factors affecting adoption include:
  • The clinical appropriateness of the consultation for remote assessment
  • The support for implementation by the organisation. For example, through supportive leadership and provision of resources to support patient and staff to adapt their work processes.

We are now exploring in-depth patient and healthcare staff experiences of remote consultations, focused on appointments with GPs about a mental health concern, and hospital cardiology departments about a heart condition.

Our evaluation of evidence for clinical and patient experiences of remote consultations during the COVID pandemic was directly shared with the regional NHS England and NHS Improvement clinical and transformation leads, enabling immediate knowledge translation. 

The collaboration is continuing to develop opportunities for future potential impact. This includes the development of 3 evaluation research proposals based on the 3 priority areas identified. This is to be used to directly inform how new care approaches are incorporated within routine healthcare delivery.

This work has also led to a collaboration between ARC NT, UCLPartners, NIHR Cancer Policy Research Unit and the UCL Clinical Operational Research Unit to evaluate the impact of Community Diagnostic Centres (CDCs) for people with colorectal and ovarian cancers.

A report on study findings was created and presented to NHSE&I London’s Clinical Advisory Group (LCEG) in 2022, entitled "Pan-London research on the shift to remote consultations during the COVID-19 pandemic: lessons learnt" 

NIHR Applied Research Collaboration (ARC) North Thames

NIHR Applied Research Collaboration (ARC) South London

NIHR Applied Research Collaboration (ARC) Northwest London

Health Innovation Network (HIN) South London AHSN

Imperial College Health Partners AHSN

UCLPartners AHSN

NHS England and NHS Improvement (NHSE&I) London