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Funding and policy incentives to encourage implementation of point-of-care C-reactive protein testing for lower respiratory tract infection in NHS primary care: a mixed-methods evaluation
  1. Matthew Johnson1,
  2. Liz Cross2,
  3. Nick Sandison3,
  4. Jamie Stevenson3,
  5. Thomas Monks1,
  6. Michael Moore4
  1. 1 NIHR CLAHRC Wessex Data Science Hub, Faculty of Health Sciences, University of Southampton, Southampton, UK
  2. 2 Attenborough Surgery, Bushey Medical Centre, Herts Valleys Clinical Commissioning Group, NIHR CLARHC East of England, Bushey, UK
  3. 3 NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
  4. 4 Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
  1. Correspondence to Matthew Johnson; mj1c13{at}


Objectives Utilisation of point-of-care C-reactive protein testing for lower respiratory tract infection has been limited in UK primary care, with costs and funding suggested as important barriers. We aimed to use existing National Health Service funding and policy mechanisms to alleviate these barriers and engage with clinicians and healthcare commissioners to encourage implementation.

Design A mixed-methods study design was adopted, including a qualitative survey to identify clinicians’ and commissioners’ perceived benefits, barriers and enablers post-implementation, and quantitative analysis of results from a real-world implementation study.

Interventions We developed a funding specification to underpin local reimbursement of general practices for test delivery based on an item of service payment. We also created training and administrative materials to facilitate implementation by reducing organisational burden. The implementation study provided intervention sites with a testing device and supplies, training and practical assistance.

Results Despite engagement with several groups, implementation and uptake of our funding specification were limited. Survey respondents confirmed costs and funding as important barriers in addition to physical and operational constraints and cited training and the value of a local champion as enablers.

Conclusions Although survey respondents highlighted the clinical benefits, funding remains a barrier to implementation in UK primary care and appears not to be alleviated by the existing financial incentives available to commissioners. The potential to meet incentive targets using lower cost methods, a lack of policy consistency or competing financial pressures and commissioning programmes may be important determinants of local priorities. An implementation champion could help to catalyse support and overcome operational barriers at the local level, but widespread implementation is likely to require national policy change. Successful implementation may reproduce antibiotic prescribing reductions observed in research studies.

  • health policy
  • primary care
  • respiratory infections

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  • Contributors MJ carried out quantitative analysis and wrote the paper with contributions from MM. MJ and NS developed the postimplementation survey and, with TM, carried out qualitative analysis. LC carried out the Herts Valleys CCG implementation study. JS, NS and MM developed the LES framework and other resources and engaged with the National Health Service. TM provided methodological input, and MM provided clinical guidance. All authors commented on drafts of the paper and have read and approved the final manuscript.

  • Funding This research was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Wessex at University Hospital Southampton NHS Foundation Trust. The Herts Valleys CCG implementation study was separately supported by a 2015/16 NHS England Innovation Challenge Prize, Acorn award.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests MJ, NS, JS, TM and MM have no competing interests to declare. LC has received honoraria from Abbott Laboratories and Roche Diagnostics Ltd for speaking events.

  • Patient consent Not required.

  • Ethics approval The Integrated Research Application System confirmed that formal ethical approval was not required for the Herts Valleys CCG implementation study, which is a service evaluation project.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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