Social and Ethical Aspects of Remote and Hybrid Care in the Special Allocation Scheme in general practice (SEARCH): A mixed methods feasibility study protocol

<ns3:p> Background Despite the growing body of research on remote primary care and access for (digitally) excluded groups, very little is known about care for patients who have been <ns3:italic>deliberately</ns3:italic> excluded from mainstream services. The ‘Special Allocation Scheme’ (SAS) in England provides GP services to patients who have been excluded from their GP practice after being reported for violent behaviour. Patients registered on SAS are likely to be offered remote services, in part because patients are often placed in an ‘out-of-area’ SAS practice. Our aim is to find out more about the needs of patients on the SAS, whether and when it is appropriate to offer remote options, and who these options might benefit or disadvantage. We also aim to develop safe, ethical, and meaningful ways to involve patients with experience on the scheme in research and service development. Methods Workstream 1 includes a national scoping survey of SAS provision across England. Workstream 2 comprises of three ethnographic case studies of SAS services, including observation and interviews with patients, NHS staff and national/regional decision makers. Workstream 3 involves two codesign workshops with patients, researchers, clinicians, support staff and third sector care providers to co-produce a set of reflections and best practices to inform future research and service redesign in this context. An iterative and participatory-informed PPIE approach is adopted throughout, involving patients and other stakeholders from early conceptualisation to study design, analysis and codesign of outputs. Conclusions Whilst remote solutions can improve access to primary care for some, they are not suitable for every patient population and can widen health inequalities. This is a novel study in a critically under-researched area of service delivery with clear practical and ethical implications for practice. Findings will develop understanding and transferable learning for SAS delivery and inform the design of a future study. </ns3:p>