Decluttering primary care in England to improve patient safety

Reducing the provision of low-value interventions that expose patients to unnecessary risk of harm, both directly, and indirectly, is key to promoting patient safety and reducing healthcare costs. Over the last two decades, there has been significant attention from the policy and academic community on reducing the provision of low-value care that exposes patients to risk of harm. For example, the development of guidance (i.e. “do not do” recommendations from the National Institute for Health and Care Excellence), shared decision making (i.e. the Choosing Wisely initiative), and clinical audit and feedback systems (i.e. integrated within electronic health records). Despite this, many ineffective and harmful interventions continue to be used in routine clinical practice. 

 The aim of this PhD is to declutter primary care by reducing the provision of low-value interventions with limited clinical- and cost-effectiveness, and where the risk of harm exceeds likely benefit. This will be achieved by: (i) establishing a list of indicators to measure low-value care that expose patients to risk of harm in English general practice, (ii) analysing routinely collected administrative data to examine micro (i.e patient and clinician) and macro (i.e practice characteristics) factors that drive the provision of low-value care that expose patients to risk of harm, and (iii) identifying enablers and barriers to sustainable behaviour change in primary care required to reduce provision of low-value care that exposes patients to risk of harm

 This PhD project will take a mixed-methods approach and the PhD candidate will develop skills and undertake training in evidence synthesis, consensus studies, quantitative analyses of healthcare administrative datasets, and qualitative research techniques. Collectively, this PhD project will develop actionable evidence that can inform policy and promote the delivery of safe, effective, and high-quality care delivery in English general practice. 

Entry Requirements

Candidates are expected to hold (or be about to obtain) a minimum upper second class undergraduate honours degree (or equivalent) in a related area / subject. Candidates with an interest in a related healthcare profession, or health economics, or biomedical science or psychology or social policy are encouraged to apply. Experience in health services research, and health policy is desirable. 

For information on how to apply for this project, please visit the Faculty of Biology, Medicine and Health Doctoral Academy website (https://www.bmh.manchester.ac.uk/study/research/apply/).   Interested candidates must first make contact with the Primary Supervisor prior to submitting a formal application, to discuss their interest and suitability for the project. On the online application form select PhD Primary Care and Health Services Research.