Inclusion Health Action in General Practice: Early Evaluation Report

Appendix Four: Evaluation tools

Participant Information form

Inclusion Health Action in General Practice Evaluation - Participant Information Sheet

Introduction

The Scottish Government has commissioned The Lines Between, a social research organisation, to carry out a rapid evaluation of the Inclusion Health Action in General Practice (IHAGP) programme. The evaluation aims to explore how the intervention is being implemented across a range of practices and what early successes and learning can be captured to inform decisions about the future of IHAGP and policies to tackle health inequalities.

You are being invited to take part in the evaluation, but before you decide whether to take part, it is important for you to understand what participation will involve and how findings will be used. Please take time to read the following information. You can contact the study team using the details below if you have any questions or would like more information.

What is this study about?

IHAGP was developed by the Scottish Government and other stakeholders from the recommendation for a new ‘enhanced service’ set out in the Primary Care Health Inequalities Short Life Working Group report. IHAGP provides up to £1.3 million over financial years 22/23 and 23/24 to 80 general practices operating in the most deprived areas of Glasgow.

The aim of this research is to provide the Scottish Government with information on how the IHAGP funding is being used, to learn what is working well and less well and to demonstrate early and emerging outcomes and benefits. Findings from the evaluation will be used to inform decisions about the future of the programme and policies to tackle health inequalities.

Why have I been invited to take part?

The evaluation team selected a sample of practices to reflect the diversity of characteristics (e.g. practices of different sizes or with a lot of patients who need help with language interpretation services) across all those taking part in the programme. Your practice has been selected in this sample and we would like to explore your experiences of the programme, and the activities that have been undertaken as part of it. If any of your colleagues have been involved in the programme, we would also like to understand their experiences and perspectives as well.

What will taking part involve?

If you are interested in participating, a member of the TLB team will arrange a time to speak with you either one-to-one or in a group with your colleagues, depending on your preferences. The discussion will take place on a date and time (including evenings or weekends) that is convenient for you. It can be over the phone, video call, or in person. One-to-one discussions will take between 30-45 minutes, and group discussions will last around an hour. The areas that we explore during these discussions will be tailored to reflect your role and how IHAGP funding has been used, but will cover the following themes:

• how IHAGP funding have been used at your practice;
• the progress that has been made, including enablers, challenges, and barriers to this;
• the learning that has been gained,
• and any impacts IHAGP has had;sustainability of actions and activities.

What else do I need to know?

• Taking part is voluntary. It is up to you whether you participate in the study.
• Taking part is confidential. Your participation in the discussion will be confidential, and we won’t share any information that could identify you to anyone else.
• There are no right or wrong answers; this research is purely to understand different experiences and views, and you do not need to answer any questions that you do not wish to.
• We might use some things you say in the report that we write for the Scottish Government. While the discussion will inform the findings that we present in the report that we produce, we will not attribute any findings to an individual or organisation.
• You can change your mind about taking part. Even if you are initially happy to have a discussion with us, you can change your mind at any time. If you decide that you want to withdraw from the study after the discussion has taken place, please contact Derek at TLB using the contact details below. We will not be able to exclude the information you have provided after it has been anonymised or used in analysis or the report. In this case, your rights to access, change or move your information will be limited as we need to manage your information in specific ways for the research to be reliable and accurate.
• We will ask to audio record the discussion with you. This is to ensure that we have an accurate account of our discussion and to draw on relevant quotes to include in the final report. Recorded discussions will be transcribed, after which the recording will be deleted. If you do not want us to record the discussion, we will take handwritten notes, which will be typed up without your name. The handwritten notes will be destroyed, and the typed version deleted at the end of the study.
• Any personal information will be held securely. Interview notes and transcripts will be stored securely, in line with UK data protection legislation. TLB’s privacy notice explains your rights in more detail. Any personal information will be deleted at the end of the study. You can ask us to delete any personal data we have about you at any time. To do this, please speak to us or email hello@thelinesbetween.co.uk, and tell us to delete your data.
• The evaluation report will be published and publicly available. The evaluation report will be published by the Scottish Government and will be shared with all practices that have contributed to the evaluation. There will also be a learning event organised to share the findings.

What next?

If you agree to taking part, a member of the TLB evaluation team will liaise with you to make arrangements for the discussion to take place. Before the start of any one-to-one or group discussion the team member from TLB will ask you to verbally confirm that you have understood the information in this document, and consent:

• To take part in an interview.
• For the interview to be audio recorded.
• For anonymised quotes from you to be used in the report we write.

What if I have a complaint or concern about the evaluation?

If you have any concerns about the evaluation or the conduct of the evaluation team, please contact the Contract Manager at the Scottish Government.

Who can I contact if I have any questions?

If you have any questions or want to discuss this information, please don’t hesitate to contact The Lines Between.

Thank you for taking the time to read this information. Please retain a copy for your reference.

Privacy Notice

Inclusion Health Action in General Practice Evaluation

Privacy notice for interviewees

About the project

The Scottish Government has commissioned The Lines Between, a social research organisation, to carry out a rapid evaluation of the Inclusion Health Action in General Practice (IHAGP) programme. The evaluation aims to explore how the intervention is being implemented across a range of practices and what early successes and learning can be captured to inform future planning and delivery.

About this privacy notice

This privacy notice is for those taking part in this research. It explains how your personal data will be collected for the purposes of this research are used and handled.

The Scottish Ministers are the “data controller”. The data controller decides what personal data is collected from you as part of this research.

The Lines Between is the “data processor” for this research, which means that The Lines Between is responsible for collecting information from you during an interview or survey, securely storing it, and using it to write a report on behalf of the Scottish Government.

About The Lines Between

The Lines Between is a specialist research agency. All research staff have Basic Disclosure and adhere to the Social Research Association Code of Ethics and RESPECT Code of Practice. They revisit these guidelines at the start of each project along with the ESRC's frequently updated Framework for Research Ethics.

What happens to the information you provide and how is your privacy protected?

With your consent, The Scottish Government will share your contact details with The Lines Between (name, job role, practice name and your email address at the practice), who will contact you and arrange an interview, if you would like to take part in the research. Sharing your data and participating in the research are both entirely voluntary and can be withdrawn at any time.

With your consent, the Scottish Government will also share your monitoring forms with The Lines Between. These will not form a formal part of the evaluation but will provide background knowledge and context.

The information collected during the interview will be used for research purposes only. The Lines Between will use the information to write a report for the Scottish Government who will publish it, but this report will not contain any personal data.

Personal data can be collected and used in this way under the terms of data protection legislation in the UK on the grounds of “public task”. The data collected as a part of this evaluation will be used to provide the effective provision of health services in the public interest in accordance with the NHS Act 1978.

The Lines Between will treat the information you give them in the strictest confidence under the Data Protection Act 2018, the UK General Data Protection Regulation (GDPR). Only The Lines Between research team will have access to your personal data and this will be stored securely, in a protected electronic folder that only the immediate research team have access to. The data is stored on a UK server and will not leave the UK. No information that could make a person identifiable will be passed on to the Scottish Government.

Where and how long your information is retained

All personal data and interview responses are stored securely and confidentially under the terms of data protection and in line with international best practice.

The Lines Between will only retain your data in a way that can identify you for as long as is necessary to support the research project and findings and will be deleted at the end of the study or earlier if no longer needed.

Your rights

Data protection legislation gives rights to individuals in respect of the personal data that organisations hold about them. These include the right to:

• access a copy of the information an organisation holds about them;
• rectify any information they think is inaccurate or incomplete;
• restrict the processing of their information in certain circumstances;
• object to processing that is likely to cause or is causing damage or distress;
• complain to a supervisory authority if they are unhappy with the way in which their data has been processed.

Questions or queries

If anything in this privacy notice is not clear or you would like us to talk you through it, please contact the Scottish Government:

By post:

St. Andrews House, 2 Regent Road, Edinburgh EH1 3DG

If you have questions or concerns about how your personal data is being collected or used, or if you believe that The Lines Between have not complied with your data protection rights, you can contact the Data Protection Officer at the Scottish Government. If you have questions about your personal data held by the data controller you can also contact the Data Protection Officer at the Scottish Government:

By email:

DataProtectionOfficer@gov.scot

By post:

Victoria Quay, Commercial Street, Edinburgh, EH6 6QQ

Complaints

You have the right to lodge a complaint with the Information Commissioner’s Office. If you are unhappy with the way your personal data are being processed, you can report it to the Information Commissioner’s Office (ICO) or by calling the ICO helpline on 0303 123 1113.

Discussion Guide – Practices participating in IHAGP

Inclusion Health Action in General Practice Evaluation: discussion guide

Role and aspirations

1. Can you give me an overview of your practice? (probe the following):

• Practice size
• Staff numbers and roles
• Patient population characteristics

2. What is your role at the practice?

3. What has been your role in the IHAGP programme and activity that has been delivered?

• How did you come to be involved in the programme?
• What were the key drivers and/or motivations for involvement? What were you hoping to achieve?

4. To what extent do you feel that your aspirations for the programme have been met?

• Why do you say that?
• Do you think that the IHAGP programme is an effective means of addressing higher levels of unmet need in deprived areas?

Aims and progress

5. Which of the three IHAGP themes did your practice decide to implement and why was that/were those the focus?

• (If not covered in answer to the above) – Why did you decide to deliver activity under more than one theme?
• To what extent does the activity under each of the different themes complement each other and contribute to what you hoped to achieve?

6. Has IHAGP funding been used to start a new initiative/new activity under one or more of these themes, or used to supplement/enhance activity that was already happening in the practice?

• If used to supplement/enhance - what has this enabled that wouldn’t have happened otherwise

7. Can you tell me about initial delivery plans and intended approach (Tailor follow-up questions to theme/s implemented):

Theme one (patient engagement)

• What was the starting point for this activity?
• Were you building on any work that had already been undertaken or has this been the catalyst for new patient engagement activity?
• where has/is implementation been/being targeted
• Did you engage with any existing peer support or community groups to support this activity?
• Did this activity involve the Practice Community Link Worker? If so, can you tell me a bit about that?
• How did you recruit patients, how was recruitment done, what type of activities were they asked to participate in?
• What was the rationale for those initial plans and approaches?
• What were you trying to achieve through patient engagement activity?
• Have there been any changes to those initial plans and approaches?

i. If so, what were those changes and what influenced them?

ii. What difference did they make?

Theme two (enhancing workforce knowledge and skills)

• where has/is implementation been/being targeted,
• What type of training or activity did you introduce
• How did you identify staff to participate?
• What was the rationale for those initial plans and approaches? What were you trying to achieve?
• Have there been any changes to those initial plans and approaches?

i. If so, what were those changes and what influenced them?

ii. What difference did they make?

Theme three (enabling proactive outreach or extended consultations)

• Where has/is implementation been/being targeted, what type of activity did you introduce, how did you identify patients to target?
• What was the rationale for those initial plans and approaches? What were you trying to achieve?
• Have there been any changes to those initial plans and approaches?
• On reflection, were those the right changes to make? Why is that?

i. If so, what were those changes and what influenced them?

ii. What difference did they make?

8. How would you describe the progress that has been made? (Exploring: what has been implemented and delivered to date )

• What are the key IHAGP activities have been implemented?
• Are you where you’d hoped to be at this point?

i. Why do you say that?

• What have been the key successes and achievements so far?
• What have been the enablers of the progress that has been made?
• Which are the elements of the programme that have seen the least progress?

i. What factors have influenced this?

ii. How are these being tackled?

iii. What support would you benefit from to overcome these barriers?

9. Overall, what has worked well with the approach taken?

• Any factors not already mentioned that have been most critical to implementation and delivery success?

10. Overall, what could have worked better?

• Any factors not already mentioned that have presented the most significant challenges?

i. What did you do to mitigate or overcome these?

ii. What could have been done to avoid these?

Learning and good practice

11. What is the most important learning you are taking away from your involvement in the IHAGP programme?

• What would you do differently if you were starting again?
• What would be the most important learning or piece of advice that you would share with other practices that are delivering against the same theme/s?

12. What, if any, examples of good practice have been generated by IHAGP activity?

• Why do you consider these to be examples of good practice?

13. What has been the main learning for you from your involvement in the programme?

• What learning have you generated that you feel is important in shaping the future of the programme?
• Have you learned anything that might be useful to inform efforts to tackle health inequalities more generally?
• What changes could be made to the programme’s design and implementation that would make it more effective?

i. What difference would that make?

Uptake and Impacts

14. Can you please describe any patterns of IHAGP support uptake? (Tailor follow up questions to theme/s implemented)

Theme one (patient engagement)

• How well have patients/communities engaged in involvement opportunities?
• Has there been variations amongst patient groups/communities and if so, why do you think that is?
• Were you able to recruit the patient population you hoped you would (i.e. diversity, health conditions etc)

Theme two (enhancing workforce knowledge and skills)

• Are there variations in the extent to which training/activities have been taken up by staff? (e.g. by profession, level of seniority etc).
• If so, why do you think that is?
• To what extent has the training activities resulted in learning influencing and being embedded in practice, process, and policies?

i. Why is that?

Theme three (enabling proactive outreach or extended consultations with patients at high risk)

• How well have you managed to engage patients in outreach or extended consultation opportunities?
• What has influenced this?
• Have there been variations amongst patient groups and if so, why do you think that is?

15. What benefits and positive impacts have been generated as a result of IHAGP delivery (exploring impacts, both positive and negative on):

• Patients that have directly accessed IHAGP opportunities (either through accessing opportunities themselves, or, if theme 2, engaging with staff that have engaged in training and support)?
• The wider patient population?
• Individual staff that have been directly involved in IHAGP activity or delivery?
• The wider staff team?
• The practice’s policies, processes, and systems?
• The practice overall

16. Have there been any unanticipated benefits or wider impacts?

(exploring eg development of any communities of practice and/or peer support with other general practices in deprived areas, impacts on morale/motivation/feelings of burnout through opportunities created?)

17. Have there been any negative impacts of IHAGP activity?

18. Are there any alternative activities/themes that could be delivered with a similar budget that you think would still align with the ambitions of the IHAGP programme but with a greater impact?

• To what extent do you feel that the IHAGP is an effective approach to supporting general practice in addressing health inequalities?
• Why do you say that?

Future and sustainability

19. How sustainable are the developments introduced to-date- as part of the IHAGP programme? (exploring the extent to which they are sustainable without and with future funding)

• Why do you say that, and what are the factors that will influence this positively and negatively?

20. What are the key priorities for future development and delivery of the IHAGP programme at your practice?

• What are the factors that will be critical to achieving this?
• What are the perceived challenges of this?

i. How are these being mitigated/how can these be overcome?

21. Is there anything that we have not covered that you wanted to say about the IHAGP programme?

Sample Monitoring Form

Theme Two: Enhacing workforce knowledge and skills for health in equalities.

"To provide practices with support to help and enable staff (including administrative and management, clinical and link workers) to access education, knowledge resources or training on health inequality and health equity."

Please complete the form below in full on excel and return to: healthinequalitiesprimarycare@gov.scot by 15 December 2023

Question	Response
Spend: please indicate how much of the IHAGP payment received in September 2023 you have used or plan to use for this theme alone.
Actual spend to 15 Dec 2023 (£)
Planned spend (£)
Estimated date to spend all of the Sept payment (if relevant) (£)
Brief description/breakdown of spend
Activities: please provide a brief description of the actions you have taken (e.g. learning activities staff have undertaken, resources purchased)
Reach: provide an approximate numbers of staff that have undertaken training. Please describe your evidence for this.
Reach: give further details (e.g. role and numbers staff who have accessed relevant education resources or training; length and/or regularity of training) Please describe your evidence for this.
Outcomes: describe how the activity has impacted on the practice. (E.g what practical changes have happened or will happen as a result of training/learning; impact on staff) Please describe your evidence for this.
Outcomes: describe how the activity has impacted on the patients involved. Please describe your evidence for this.
Barriers: describe any barriers or challenges you have encountered. Information about what practices may have found difficult is valuable for learning and for the potential development of future resources/support for practices.
Learning: describe key learning to share with other practices (e.g. useful webpages, patient or staff feedback or practical tips)
Learning: do you have suggestions for additional support or resources which would help practices to deliver actions under this theme

Note: different forms were completed depending on the theme being undertaken. Each form collected similar information with slightly different wording depending on the theme.