You will be asked to nominate a ‘research champion’ within your practice. This person will be the main contact with the ERICA team. We will ask you to organise a practice team meeting to discuss the trial and to seek agreement from your colleagues to participate. Our suite of trial videos can be used to provide summary trial information. If you would like to participate, the research champion and practice manger will need to complete a practice agreement indicating a meeting has taken place and at least half of GPs are supportive of the study and using the eRATs within their clinical practice.
Your practice will then be randomly allocated to either the intervention arm or the control arm. Practices allocated to the intervention arm will be given access to the eRATs. The study team will help with the process. There will be some training videos on the use of the eRATs along with a short quiz for the research champion to complete prior to the start of the study.
Once the eRATs have been embedded in the practice they should work across all practice computers and be available to all GPs. GPs will use eRATs as support tools – the eRATs do not give orders. The GP will not be expected to refer every time the RAT prompt goes off. Instead we hope the eRATs will provide a useful tool to alert GPs to the small possibility of cancer. The GP will use their clinical judgement on how best to manage the patient, be it referral, in-house testing, or safety netting.
Practices allocated to the control arm will provide care as usual.
We will ask the research champion to complete a brief ‘interim questionnaire’ after a few months into the study and an ‘exit questionnaire’ at the end of the study that will ask about how the study has impacted on the GP surgery.
If you agree to a nested study
1) GP eRAT usage and GP and patient experience of care.
A selection of GPs (from intervention and control practices) will be invited to take part in a brief interview to discuss their experience of providing care during the trial. GPs in intervention practices will also be asked about their experiences of using eRATs. Potentially interested GPs will be sent the GP interview information sheet to review which can also be viewed on the GP resources page.
A selection of patients will be invited to take part in an interview to discuss their experience of care. We are interested in the patient’s diagnostic pathway and will invite them to participate in up to three interviews across a 12 month period to explore their experiences of any ongoing care. We will need support from somebody in the practice to help us identify and send initial invite letters to potential participants. The study team will provide the letter and all materials.
2) Patients’ health resource use.
A selection of identified patients will be sent a letter from the practice (written by the research team, all materials provided by the research team). The letter will ask participants to a) either give permission for the research team to review their medical records or b) give permission to review their medical records and provide consent to complete a short questionnaire about quality of life and resource use at two time points over the next couple of months. The questionnaire will ask patients to report on the use of specialised NHS resources that are typically difficult to identify via medical notes review. If patients agree to medical notes review, a member of the research team will need to be provided with computer log-in details and allocated some space at the practice to conduct the review. Medical record review will capture the patients’ NHS resource use over a two month period, from the date in which the eRAT fired (or would have done in control practices, if eRATs were available).