health services research uk conference 2023

Welsh Government

Health Services Research UK Conference 2023

The Health Services Research UK (HSR UK) conference committee is developing an exciting programme with high quality speakers from across the UK, covering key issues for the HSR community. There will be some great plenary sessions, practical and interactive workshops, HSR learning and development sessions and the opportunity as always to showcase and discuss your research.

HSR UK is dedicated to the promotion of health services research in policy and practice. The annual conference is open to everyone interested in health and care services and systems research, both based in the UK and internationally, and offers you the opportunity to:

• Engage with cutting-edge research. The programme is multi-disciplinary, with a wide range of research presentations and interactive workshops selected for their importance and impact, alongside plenaries from key opinion leaders in research, policy and practice.
• Build your networks and hear from the agenda-setters. Throughout the three day event and on the interactive conference platform you will have the chance to build your networks across research, policy and practice communities, form new collaborations, and engage with influencers and decision makers.
• Present your own research to the widest possible audience. Participants attend from universities and research institutes, research funding agencies, government, NHS and social care bodies, key peer reviewed journals, industry, consultancy, and the third sector.

Registration will open soon.

Call for abstracts

You are invited to submit proposals for research presentations, workshops, and learning and development sessions for inclusion in the programme. HSR UK are particularly interested in enriching the conference this year with contributions which come from across the four nations of the UK or a variety of professional settings, including nursing and allied health professions.

For more information on submitting an abstract, visit the conference website.

Deadline: 12:00 on 16 January 2023

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Health Services Research UK Conference 2023

• 4 - 6 July 2023
• Birmingham, UK

Save the date for HSR UK 2023!

HSR UK’s 16th annual conference will take place in Birmingham.

Delegates from HSR UK member organisations will have access to discounted rates on top of the usual Early bird offer.

Health Services Research UK (HSR UK) conference 2023

• Event date From July 4, 2023 to July 6, 2023
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Save the date for Health Services Research UK (HSR UK) 2023!

HSR UK’s 16th annual conference will take place in Birmingham.

They are developing an exciting programme building on their evaluation of their successful 2022 event in Sheffield, full of high-profile speakers, cutting-edge research and new social events and networking opportunities. The programme will include lots of ARC West speakers.

Joining instructions

This event is organised by Health Services Research UK (HSR UK) so please contact them to find out more.

• Email:   [email protected]
• Web:   Book online

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Health Services Research UK Conference 2023

4 july 2023 - 6 july 2023.

The Health Services Research UK’s 16th annual conference will be held from 4 to 6 July 2023 in person at the University of Birmingham.  For those who are unable to join in person, it will be offering an online option allowing access to the conference platform and on-demand content.

The conference committee is developing an exciting programme with high quality speakers from across the UK, covering key issues for the HSR community. There will be some great plenary sessions, practical and interactive workshops, HSR learning and development sessions and the opportunity as always to showcase and discuss your research.

The aging population, with the growing burden of chronic conditions and multimorbidity, is constantly increasing the demand for more comprehensive, efficient and smarter personalized care delivery based on innovative solutions. For this reason, the transformation of health systems in Europe with the design, development and implementation of innovative digital solutions, ensuring systems’ sustainability is highly needed.

In this framework, JADECARE, the EU funded “Joint Action on digitally enabled integrated person-centred care”, aims to contribute to innovative, efficient and sustainable health systems providing expertise to assist the European Countries in undertaking health system reforms. It intends to support the transformation of health systems by successfully addressing the transfer and adoption of four “original Good Practices” (oGPs) to 21 other settings of “Next Adopters” (NAs).

JADECARE involves partners from 16 European countries holding different levels of penetration, adoption and maturity of integrated care, providing a complete scenario of different idiosyncrasies. The project started on October 1st, 2020 and ends on September 30th, 2023.

The challenge of this JA is to transfer innovations that have proven to be successful to heterogeneous and complex healthcare environments by adapting the practices to be transferred to the local needs, situation, capabilities, resources, plans, strategies and current implementations of the NAs.

For this reason, great focus has been dedicated to the preparation of the local environments. During the pre-implementation phase the 21 NAs identified more than 150 needs and defined 64 interventions and action plans that will target more than 4 million inhabitants.

Health Services Research UK (HSR UK) is dedicated to the promotion of health services research in policy and practice. The annual conference is open to everyone interested in health and care services and systems research, both based in the UK and internationally, and offers you the opportunity to:

• Engage with cutting-edge research. The programme is multi-disciplinary, with a wide range of research presentations and interactive workshops selected for their importance and impact, alongside plenaries from key opinion leaders in research, policy and practice.
• Build your networks and hear from the agenda-setters. Throughout the three day event and on our interactive conference platform you will have the chance to build your networks across research, policy and practice communities, form new collaborations, and engage with influencers and decision makers.
• Present your own research to the widest possible audience. Participants attend from universities and research institutes, research funding agencies, government, NHS and social care bodies, key peer reviewed journals, industry, consultancy, and the third sector.
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• Outlook 365
• Outlook Live

Public Health Science

A national conference dedicated to new research in Public Health in the UK and Ireland

UK Public Health Science 2023: a call for abstracts 

We are delighted to invite abstract submissions for Public Health Science : A National Conference Dedicated to New Research in UK Public Health, to be held in London, UK, on Nov 24, 2023. This annual conference showcases the quality and impact of public health research in the UK and Ireland by bringing together researchers, practitioners, and policy makers to discuss important public health issues, perspectives, methodologies, findings, and implications for public health practice, policy, health services, and research. 

We welcome abstracts on all topics and disciplines that affect public health. We encourage perspectives from those working across all sectors and disciplines, including, but not limited to, the National Health Service (NHS), local authorities and commissioned services, charities and advocacy organisations, universities, and government bodies. 

For this year’s conference we encourage multidisciplinary submissions that focus on public health for an ageing population. Increasing life expectancy within the UK and worldwide brings major public health challenges through increased frailty, more prevalent disability and burden of disease, and greater requirement for health and social care monitoring and intervention in the population. The UK’s ageing population therefore places huge pressure on our entire national healthcare infrastructure. Maximising the health and wellbeing of the older population is important, and so too is the challenge of nurturing and protecting the longterm wellbeing of our younger populations, who collectively face uncertain futures posed by austerity, conflict, climate change, enduring and pervasive inequalities, and the lasting effects of the COVID­19 pandemic. This year we therefore particularly invite discussions related to intergenerational justice—namely, how to ensure fair policies and outcomes across all generations. How, for example, are current public health interventions and policies adapting to an ageing population, and how might these changes impact wider lifecourse interventions in public health intended to improve the health of younger generations, now and in the future? 

The conference will consist of oral paper presentations, chaired poster sessions, and keynote speeches. Submissions are now open for oral and poster presentations. Abstracts can be submitted under any of the three core categories: creativity in public health science; new methodological approaches to public health science; or impact and implementation of public health science in policy and practice. Research described in the abstracts may have been undertaken anywhere in the world, but must be relevant to public health science, practice, and policy in the UK and Ireland. We welcome submissions from individuals in the early stages of their careers. 

Abstracts should be a maximum of 300 words, be written in English, and contain no references, tables, or figures. Submissions should include the following sections: background (including context and aim); methods; findings; and interpretation. Please also include a non­declaratory title (including a study descriptor— eg, retrospective cohort study, randomised controlled trial); names, titles, highest degrees, and affiliations of authors; postal and email address for the corresponding author and (if different) the presenting author; whether the presenting author is an early career researcher; any funding received (please also state if none); and a brief summary of each author’s contributions and competing interests. Abstracts should not have been previously published elsewhere and must include some results (results of ongoing analyses are acceptable). Reports of randomised controlled trials should follow the  CONSORT extension for abstracts guidance . Abstract guidelines are available on  The Lancet ’s website and  guidance on how to submit is available here . Any abstracts that are not correctly formatted will be rejected without peer review. 

Submit your abstract as a Microsoft Word document through  The Lancet ’s online submission system , stating in your covering letter that the submission is for the UK Public Health Science Conference 2023. All abstracts will be considered for oral and poster presentations. The deadline for abstract submission is May 15, 2023. After  The Lancet ’s peer review process, successful applicants will be informed of acceptance of their abstract for oral or poster presentation by Sept 15, 2023. Abstracts accepted after peer review will be published online by  The Lancet . 

In recognition of the contribution that early career researchers make to public health, we will again be awarding prizes for the best oral and poster presentations by early career researchers. These prizes are sponsored by the NIHR School for Public Health Research . If you wish to be entered into this competition, please indicate in your submitted manuscript whether the presenting author is a pre­PhD researcher (eg, MSc student, foundation year trainee, research assistant, public health trainee, or academic clinical fellow), PhD student, or postdoctoral trainee (eg, clinical lecturer, clinician scientist fellow, early career post­doc, or equivalent posts). In addition, an event for early career researchers will be organised on the day before the conference.

Does your research involve people with lived experience? At this year’s Public Health Science: A National Conference, UCL’s new Online Master of Public Health are awarding £200 each to one oral presentation and to one poster presentation which have most effectively and equitably involved people with lived experience in their work. All abstracts that clearly include lived experience in their methods and results will be considered for this prize. These new prizes have been created to reflect a core and underpinning value of the newly launched Master of Public Health programme, which is the importance of involving people with lived experience in public health research, service, policy, and education. Through harnessing the expertise of public health academics, leaders, practitioners, and people with lived experience, this MPH degree, launched in 2022, blends classical population health sciences with an innovative interdisciplinary approach to enable graduates to bring world-class learning to their future employment and the field of public health science. Find out more about the UCL Online Master of Public Health by  watching this video  or by visiting our websites:  MPH Prospectus  and the  UCL Faculty of Population Health Sciences .

In line with our ongoing commitment to work towards delivering a net­zero conference, details of the conference carbon reduction plans and carbon offsetting will be published on the website in due course. The conference will be preceded by an early career researcher event and by a networking conference dinner on Nov 23, 2023. 

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6th UK and Ireland Implementation Science Research Conference 2023

Sustaining health and public services in an uncertain future: what role for implementation science.

When: 13 and 14 July 2023 Where: University of Limerick, Ireland & Online

Now in its sixth year, the 2023 conference will bring together scientists, researchers, policymakers, clinicians, practitioners, service users and the public from around the world.

Together, we will discuss how implementation science can help to sustain and develop health and public services, against a background of social, geopolitical, technological and environmental change.    

Find out more  

For the most up to date information on plenary speakers and to register your interest, visit the NIHR ARC South London website .

“Great mix of lectures, talks, rapid sessions and posters. Funnily…online makes it easier to take notes/refs etc. Awesome organisation and chairing”

A delegate from 2021

“Great mix of early career researchers and more senior scientists”

A delegate from last year’s conference

The virtual format

This year’s virtual format  included oral and poster presentations organised under specialist themes, meet the experts sessions, roundtable discussions, Q&A sessions and online networking. 

The conference was organised by the Centre for Implementation Science at King’s College London. It was supported by the NIHR ARC South London , a research organisation working to improve health and care services, the UK Implementation Society , and BMC. 

Plenary speakers

The virtual conference featured three plenary lectures from leading international researchers and practitioners. Our speakers were:

Dr John Øvretveit , director of research and professor of healthcare innovation implementation and evaluation at the Medical Management Centre, The Karolinska Institute, Stockholm.  John will discuss:  Improve-mentation for an effective response to Covid-19 – the Swedish experience

Jessica Read , deputy chief midwifery officer, NHS England, who has extensive experience over a 30- year career of implementing organisational change and service improvement. Jessica will discuss: The challenges and successes of implementing policy into practice and the impact of Covid-19

Dave Taylor from The Patients Association, an expert in implementing digital health technologies. Dave will discuss: Patient perspectives on uses and abuses of IT in healthcare

Health Services Research and Pharmacy Practice Conference 2023

This year's theme is  partnerships in healthcare: advancing sustainable medicines optimisation, monday 17 april - tuesday 18 april 2023, hosted by the university of bradford,  bradford, west yorkshire, bd7 1dp.

The deadline for abstracts has now passed and we are no longer accepting submissions.

About the conference

Pharmacy has been an integral part of the NHS to deliver the medicine optimisation in both primary and secondary care. As new services and patient pathways are being developed and delivered, the role of pharmacy team is expanding to enable and support patients to manage their own health whilst remaining in their own homes where possible.

Although medication is the most common health intervention, medication-related harm constitutes the greatest proportion of the total preventable harm in healthcare. The World Health Organization (WHO) patient safety challenge launched in 2017 aimed to reduce harm from medicines by 50%, globally in the next five years, and medication without harm theme has been selected for World Patient Safety Day 2022.

The reduction and prevention of the medication-related harm can only be achieved by working within and across complex adaptive systems with our healthcare professional teams and putting patients and their carers at the heart of our services. Furthermore, sustainable medicine optimisation is even more important as we encounter limited healthcare resources and challenges in the healthcare system.

In this 29th HSRPP Conference, we welcome research addressing delivery of sustainable medicine optimisation with the focus around the four principles of Medicines Optimisation and additional strand focusing on sustainable solutions:

• Aim to understand the patient’s experience
• Evidence based choice of medicines
• Ensure medicines use is as safe as possible
• Make medicines optimisation part of routine practice
• Sustainable healthcare solutions for modern age

Following the success of the online 2021 and 2022 conferences, we will return to an in-person conference. We are very excited about the host of fantastic speakers and workshops we have planned for HSRPP 2023. The programme will include inspiring keynote speakers, excellent research oral and poster presentations, and developmental workshops focusing on the conference theme. We will also run a Ted Talk panel debating what sustainability is in healthcare, including pharmacy, and how it will look in the future. Support for conference attendees will also be a focal element with the integration of wellbeing activities into the conference schedule.

Find out more about the team of organisers .

Keynote speakers

Professor john wright.

Bradford Institute for Health Research

John Wright is a doctor and epidemiologist with a background in hospital medicine and public health in the UK and in Africa. He established and leads the Bradford Institute for Health Research and Wolfson Centre for Applied Health Research, working to speed up translation of medical research into practice and policy. He is the Director of Research for the City of Bradford and Director of the NIHR Yorkshire and Humber Applied Research Collaboration. He is Visiting Professor in Clinical Epidemiology at the Universities of York, Leeds and Bradford and has authored over 500 papers and three textbooks and been awarded over £150 million in research award funding, £50 million as chief investigator

In 2007 he set up the Born in Bradford (BiB) cohort study which is following the lives of over 13,000 families as their children grow up. Evidence from BiB studies has informed local, national international policies and led to improvements in clinical practice and public health as well as a successful City of Culture award. In 2016 he set up Born in Bradford’s Better Start – the world’s first experimental birth cohort - to test new approaches to providing the best support in the crucial period of early life. In 2019 he established ActEarly to develop a whole systems City Collaboratory approach to improving the health and life chances of children from deprived communities in London and Yorkshire.

He has worked to develop sustainable public health programmes in Africa for 30 years including setting up and running an Ebola Treatment Centre for Doctors of the World in Sierra Leone during the Ebola epidemic. He was the research and scientific lead for Clinical and District Gold command during the COVID19 pandemic and set up the COVID19 Scientific Advisory group (CSAG). He has reported for the BBC on programmes covering Born in Bradford , Ebola and most recently The NHS Frontline podcast .

Professor David Alldred

University of Leeds

David Alldred worked as a clinical pharmacist in secondary care for five years before joining the University of Leeds as a research clinical pharmacist conducting a randomised controlled trial of pharmacist-led medication review for care home residents; this research formed the basis of his PhD. Following this, Dave was Lecturer in Pharmacy teaching pharmacology, therapeutics, pharmacy practice, evidence-based medicine, patient safety and medicines partnership.

He was appointed as Senior Lecturer in Pharmacy Practice at Bradford School of Pharmacy in 2013, and in 2015 was awarded the Pharmacy Practice UK Research Award and became a Fellow of the Royal Pharmaceutical Society. Dave was appointed as Associate Professor in Pharmacy Practice at the University of Leeds in 2015 and Professor of Medicines Use and Safety in 2017. He leads the Medicines Optimisation research theme for the School of Healthcare and is also the Deputy Lead for the Safe Use of Medicines theme in the Patient Safety Translational Centre.

His research focuses on improving the use of medicines, particularly for frail, older people including those living in care homes. Dave managed the Care Homes' Use of Medicines study (CHUMS), a UK Department of Health funded national study of medication errors in care homes, which has had a significant on practice and policy. He was a member of the Guideline Development Group for the National Institute for Health and Care Excellence (NICE) Medicines Management in Care Homes Good Practice Guidance. He leads work streams on two NIHR Programme Grants for Applied Research - CHIPPS (testing the effectiveness and cost-effectiveness of pharmacist prescribing in care homes) and ISCOMAT (improving the experiences and outcomes for heart failure patients post-discharge through best use of medicines). David have recently been working with NHS England to implement a national Medicines Optimisation for Care Homes scheme.

Professor Bryony Dean Franklin

Director of the Centre for Medication Safety and Service Quality

Professor Bryony Dean Franklin BPharm BA MSc PhD FRPharmS FFRPS

Professor Bryony Dean Franklin is a hospital pharmacist and Director of the Centre for Medication Safety and Service Quality (CMSSQ), a joint research unit between Imperial College Healthcare NHS Trust and UCL School of Pharmacy, where Bryony is Professor of Medication Safety.  She is a theme lead for both the NIHR Imperial Patient Safety Translational Research Centre and the NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London.

Bryony has been involved with patient safety research for more than 25 years; she has published widely on medication safety, the evaluation of various technologies designed to reduce errors, and the patient’s role in patient safety. Her current post combines research, quality improvement, education and training, and hospital pharmacy practice.  Bryony is Co-Editor-in-Chief for the journal BMJ Quality and Safety. She is also co-editor of the textbook “Safety in Medication Use” and co-author of “Going into Hospital?  A guide for patients, carers and families”, a book aimed at the general public. In addition to her paid work, she is a Church of England parish priest. 

Panel discussion: Sustainable solutions for a modern age

Professor amir sharif.

Dean of the Faculty of Management, Law and Social Sciences, University of Bradford

Amir M. Sharif is the Dean of the Faculty of Management, Law and Social Sciences and Professor of Circular Economy. Starting his academic career as a researcher within the field of artificial intelligence, Amir rapidly developed his research interests to apply his knowledge to addressing complex societal challenges in the areas of food security, circular economy, healthcare, operations / supply chain management, decision-making and humanitarian logistics. His specific area of interest is in the application of systems thinking, causal and cognitive models to explore human decision-making behaviours in complex environments

Dr Amy Booth

University of Oxford

Amy Booth is a medical doctor and PhD candidate at the University of Oxford. Her interest in sustainable health care developed when she was working during the pandemic and noticed how environmentally polluting health care provision could be. She became particularly concerned by the significant contribution of pharmaceuticals to the NHS's carbon footprint and her research looks at how to reduce the greenhouse gas emissions of the pharmaceutical supply chain.

Peter Morgan

NHS England

Peter is Medicines Net Zero Assistant Director for NHS England. The Medicines Net Zero team are working to reduce the environmental impact of the medicines used across the NHS in England. The team forms part of the Greener NHS programme, based within the Medicines Policy and Analysis Unit and combining environmental policy with medicines usage and supply. As a registered pharmacist, Peter previously worked in secondary care and primarily in aseptic services and clinical nutrition. He most recently led the aseptic service at King’s College Hospital NHS Foundation Trust as associate chief pharmacist, where he also led the equality, diversity and inclusion and sustainability work for the department. Peter undertook the Chief Pharmaceutical Officer's Clinical Fellowship scheme in 2018/19, where he formed the syllabus for the community pharmacy consultation service course and acted as a subject matter expert for a level 4 Emergency Preparedness, Resilience and Response incident. Peter also cofounded Pharmacy Declares, a group of climate conscious pharmacy professionals based in the United Kingdom.

Costas Vasiliou

Senior Medicines Optimisation Pharmacist, Medicines Safety Officer

Costas is a Pharmacist in the Bradford District and Craven Health and Care Partnership Medicines Optimisation Team. Within my role I chair the West Yorkshire (WY) Pharmacy Network for Sustainability and the Environment. A network within WY pharmacy which brings together colleagues from a variety of organisations, sectors and roles who wish to work together on reducing the environmental impact of pharmacy, medicines, and other associated products. I continue to work to embed sustainability into WY pharmacy to improve both the immediate and long-term health of our population.

See the full details of our keynote speeches and panel discussion:

Registration

Follow this link to book your place at HSRPP 2023 . You can find details of the cost of registration below. Payments are by credit or debit card only - please email [email protected] or call +44(0)1355 244966 if you require an alternative payment method.

Discounted registration

A discount is available for early bird registration up to and including 28 February 2023 (date extended).

We want to encourage students, people who are unwaged and researchers from least developed or low to middle income countries to attend HSRPP 2023. An additional discount is therefore available for these groups.  A list of eligible least developed or low to middle income countries is available via this link .

We are aware that attendance at conferences can be financially challenging. We have a limited number of bursaries to support conference attendance for those working in community pharmacy. If you wish to submit an expression of interest for this please contact  [email protected] . Please do this prior to registering for the conference.

Registration costs

Find out more and book your place .

Please note: Conference oral and guest speaker presentations may be recorded (audio and/or video). Attendees should be aware of this and by attending you consent to this taking place. Presentations which are recorded will be available to all conference attendees for a limited period of time via a dedicated link on the conference website, as soon as possible after the conference finishes.

Conference sponsors

Imaan healthcare.

Imaan Healthcare was also one of the leading providers during the Covid-19 vaccination programme, administering over half a million doses of the vaccine. We trained MPharm students and trainee pharmacists to administer vaccines, and they played a magnificent role in this operation!

Founded in 2004, Luto (Leeds University Testing Organisation) has a team of world-leading experts creating clear health information – for patients and healthcare practitioners. Luto’s mission is to write and design great digital and traditional health communications, and then test them with real people to make sure the information meets their needs. Such healthcare information, whether on screen or paper, is critical to the success of health services in Europe, the US and beyond. Increasing complexity and costs mean that patients themselves play a central role in ensuring safe, effective and appropriate treatment. They cannot play this role without clear, usable and accessible information.

Find out more

Get in touch with us for more information, there's also details of the organisers on the HSRPP23 team page.

Health Services Research UK Conference 2023

• 4 - 6 July 2023
• 9:00am - 5:00pm

Save the date for HSR UK 2023.

HSR UK’s 16th annual conference will take place in Birmingham.

Delegates from HSR UK member organisations will have access to discounted rates on top of the usual early bird offer.

Birmingham, UK

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Home » Training and Events » HSRPP: Health Services Research & Pharmacy Practice Conference » 2025 HSRPP Conference: University of Huddersfield

2025 HSRPP Conference: University of Huddersfield

To submit an abstract, or to book your ticket for the conference, please visit the dedicated HSRPP pages on the University of Huddersfield’s website. Link will be provided once available.

This year’s conference theme will be:

Pharmacy contributing to health across the lifespan

Conference chairs: Dr Nicola Gray and Dr Alison Hemsworth

N.B.  The HSRPP programme schedule will be provided nearer to the conference date.

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Road closure on Marquam Hill: Part of S.W. Campus Drive is closed until March 2025.

Center for Ethics in Health Care

Ohsu health literacy symposium, innovating for better results in health care, education, and research.

The symposium will showcase clear communication strategies and campus projects to more effectively engage with patients, research participants, and community members across OHSU’s many programs. OHSU faculty, staff, learners and administrators will be inspired by innovative approaches to help OHSU reach the ambitious goal of becoming a model health literate organization. You’ll learn how to:

• Describe organizational health literacy and describe the elements of a health literate   organization.
• Identify current communication barriers that affect health-related outcomes.
• Identify clear communication strategies to improve equitable access to understandable information in clinical, educational, and research settings.

Accreditation: Oregon Health & Science University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Credit: OHSU School of Medicine designates this virtual activity for a maximum of 3.25 AMA PRA Category 1 Credits ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Thursday, October 17, 2024

Lunch & Posters: Noon - 1 p.m. Program: 1 p.m. - 5 p.m.

OHSU Auditorium

3286 SW Research Drive Portland, OR 97239

Registration Fees

$50 with CME $25 without CME

Registration:  Click here to register.  

Submit a Poster Proposal:  Click here to submit a proposal.

Speakers & Topics

Opening speaker, launching the ohsu health literate organization initiative.

Marie Chisholm-Burns, PharmD, PhD, MPH, FCCP, FASHP, FAST, FACHE OHSU Provost

Keynote Speaker

Keynote speaker: describing a health literate organization.

Cliff Coleman, M.D., MPH Doris & Mark Storms Chair in Compassionate Communication, and Professor of Family Medicine

Breakout Topics & Speakers

Clinical breakout session.

"Developing a Health Literacy Committee" by Rachel Postman

"Conducting a Document Review" by Lia Sebring

Education Breakout Session

"4 Habits Checklist" by Cliff Coleman, M.D.

"Medical Student Testing of Delivering Serious News" by Katie Stowers, D.O. 

"Medical Taboo Game" (Presenters TBD)

Research Breakout Session

"Building a Health Literate Research Project and How-tos" by Meredith Zauflik & Larissa Yoshino 

"Layton Center Consent Forms" by Aimee Mooney 

"iDECIDE: A Low Health Literacy Decision-making Tool" by Don Sullivan, M.D. 

Feeling the pressure: what the 2023 Commonwealth Fund survey reveals about the state of the UK health system

22 August 2024

• Estera Mendelsohn
• Tim Gardner
• Ruth Thorlby
• Analytics and data
• Funding and sustainability
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Introduction

About this analysis, methods and approach, limitations, what can we learn from these survey findings.

• The Commonwealth Fund’s 2023 International Health Policy Survey asked adults in 10 countries about their experiences using health care services, including hospitals and general practices. 3,361 people in the UK responded to the survey. 
• The UK is among the better-performing countries for people reporting access to same- or next-day general practice appointments. But it performs worse on other questions, including getting a same-day answer to a medical query, accessing care outside normal hours and patients feeling GPs spent enough time with them. 
• For hospital-based care, the UK is among the poorest performing countries. The UK has some of the longest reported waiting times to see a specialist, including (with Canada) the largest proportion of people waiting 1 year or more for an appointment. On waiting more than 4 weeks to be seen by a specialist, the UK has slipped from being one of the better-performing nations in 2013 to one of the worst in 2023.
• Although the UK still has low proportions of people reporting cost barriers to accessing medical care compared with many other countries, the proportion has risen across the UK, particularly for dentistry, compared with previous surveys. More people reported struggling to afford prescriptions in England than in Scotland or Wales. 
• The findings suggest that pressures on health systems are not unique to the UK, but the cumulative impacts of the pandemic and below-average spending growth have left UK health services in a more precarious state than those in most other surveyed countries. The incoming Labour government has acknowledged the urgent need to improve the NHS in England. This survey underlines the breadth of challenges faced by the new administration and the devolved governments in primary care, hospital care and dentistry, and the scale of the gap between the NHS and health care services in some other high-income countries. 

The challenges facing the NHS across the UK are formidable. In England, waiting-time targets for routine and emergency hospital care have not been met since 2016, and the waiting list remains over 7 million . Waiting times are measured differently across the UK, but have also risen in Scotland, Wales and Northern Ireland, particularly since the pandemic. At the same time, pressure on general practice has been intense across the UK, driven by rising demand and shortages of GPs . In England, general practice appointments have increased since 2019 while the number of full-time equivalent, fully qualified GPs has fallen. 

These pressures are mirrored in the views of patients and the public. In 2023, more patients in England reported difficulties contacting their GP practice than ever before. Patients’ experiences of inpatient hospital care , particularly waiting times and staffing levels, have also deteriorated since 2020. In the 2023 British Social Attitudes Survey , people in England, Scotland and Wales reported the lowest levels of overall satisfaction with how the NHS is being run since the survey began in 1983, with record low levels of satisfaction with GP services and dentistry.

The NHS was a dominant theme in the 2024 general election, with improvements promised in the manifestos of the three main political parties. The NHS was declared ‘broken’ by the incoming Secretary of State for Health and Social Care, who has promised to diagnose the problems and fix the NHS.

The causes of the pressures facing the NHS are complex. In England, average funding growth between 2019/20 and 2024/25 has been below the long-term average (3% compared with 3.8% between 1979/80 and 2019/2020). For the UK as a whole, investment has lagged behind comparable European countries since 2010. But other sources of pressure, for example the impact of the COVID-19 pandemic , staff shortages and the growing demand for health care as populations age and develop more chronic conditions, are also being experienced by health systems in Europe and elsewhere.

To provide some context for the severity of the pressures on the UK’s health service compared with those in other countries, this analysis presents the findings of the 2023 International Health Policy Survey of adults in 10 countries on their experiences using health care services. The Health Foundation collaborated with the Commonwealth Fund on the International Health Policy Survey, which has been running for nearly 2 decades and includes surveys of GPs and older adults . 

For the 2023 survey, adults aged 18 and over in Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the US and the UK were asked about their experiences using a range of services, including primary care, hospital care and specialist care. Questions explored a range of issues such as access, use of digital technology, doctor-patient interactions, coordination and affordability. 

Previous International Health Policy Surveys of all adults took place in 2013, 2016 and 2020 and were used to analyse time trends. 

Respondents for the 2023 survey were selected, using a random sampling approach, to be representative of adults in each country. The final sample comprised of 21,341 respondents across all 10 nations, of whom 3,361 were living in the UK. Interviews were conducted via telephone or online, with roughly half of UK interviews conducted online. Response rates by country varied from 5.8% in the UK to 48.8% in Switzerland. All fieldwork was completed between March and August 2023. Data were weighted to reflect country-specific demographic distributions of adults and to account for probabilities of selection and sample design. Country-specific wording was used in the questionnaire where appropriate. 

In this analysis, we highlight statistically significant differences between the countries at 95% confidence. We do not report non-statistically significant differences (for instance, when results in the UK are not significantly higher or lower than another country). Where stated, averages are calculated as the mean percentage across all 10 countries' responses in the International Health Policy Survey. Finally, percentages are rounded to the nearest whole number, and percentages relating to very small numbers of respondents are excluded, resulting in some bar charts summing to marginally greater or less than 100%. Further information on the survey methods can be found in the 2023 International Health Policy Survey methodology report . Information on the methods used in the previous surveys of all adults cited in this report also can be found online .  

Our findings have some limitations. First, answers to the survey questions were self-reported and could have been influenced by factors beyond a person’s own experiences, for example news coverage. Such factors are likely to differ among countries, so it is important that conclusions are interpreted cautiously within the broader policy context of each health system. 

Second, the survey reflects a snapshot in time. It is not possible to know the chronology of any reported participant experience or draw causality from the associations reported. While the survey does not follow the same individuals over time, notable changes to answers compared with previous International Health Policy Surveys have been reported where available.

Third, a common limitation of all voluntary surveys is that not everybody responds. If the people who do not respond have different views on key questions than those who do, it can affect the results. While the weighting approach attempts to adjust for this non-response using known population characteristics, the lack of responses and small sample sizes make it hard to draw conclusions about the experiences of some population groups.

General practice 

Getting an appointment.

97% of people in the UK reported having access to a regular GP or GP practice, with other countries ranging from 99% in the Netherlands (the highest) to 86% in Canada (the lowest). People were asked how quickly they were able to get an appointment with a GP or nurse the last time they needed it. Of those who needed to make an appointment, around 2 in 5 people in the UK (42%) were seen on the same day or the next day (Figure 1, slide 1). This places the UK among the better-performing nations with respect to same- or next-day appointments, with only the Netherlands (50%) and Germany (49%) significantly higher. 

Other questions on experiences of contacting or getting access to GP services reveal a more mixed picture for the UK. The survey asked people how often they received an answer ‘the same day’ when they contacted their GP practice with a ‘medical concern’ during regular practice hours (although the nature of the medical concern was not asked). 53% of UK participants said they ‘always’ or ‘often’ receive an answer from their GP practice on the same day. The UK ranked lowest, alongside Canada, Australia and France, on this question, with the best-performing countries being the Netherlands (81%), Germany (75%) and Switzerland (72%) (Figure 1, slide 2). The UK’s performance on this question has worsened over time, down from 70% reporting they ‘always’ or ‘often’ receive a same-day answer in 2013. 

The UK is among the lower performers in relation to people being able to get health care during evenings and weekends. 16% of UK participants reported it being ‘very’ or ‘somewhat easy’ to get medical care during the evening, on weekends or on holidays without going to A&E, the second lowest proportion after Sweden (10%) (Figure 1, slide 3).

Use of digital appointments and tools

The UK and Australia ranked highest among the surveyed nations on the use of remote consultations in primary care, with 37% of UK participants reporting access to some remote virtual care or telehealth in the past 12 months, similar to Australia (Figure 2). The majority of people in the UK who had received primary care through telehealth said they were ‘very’ or ‘somewhat’ satisfied with their care (75%), however people in Australia, Canada, the Netherlands, New Zealand and the US all reported higher satisfaction (ranging from 80% for Canada to 87% for Australia).

The UK ranked above average in the percentage of people who said they have communicated with their regular GP practice digitally (39%) and close to the average on the proportion of people that have accessed their health information, visit summaries and laboratory results online (41%). 

Experience of GP appointments 

The UK generally performed worse relative to other countries on questions about people’s experiences seeing their doctor. When asked whether their regular GP spent enough time with them during appointments, 58% agreed this occurred ‘always’ or ‘often’ (Figure 3). People in Sweden reported similar levels (60%), while most other countries clustered around 80%. Meanwhile, 64% of people in the UK said their regular doctor ‘always’ or ‘often’ knew important information about them, the lowest percentage of any country except Sweden. The UK performed better on other aspects of GP appointments but not as well as other surveyed nations. 71% felt they were sufficiently involved in decisions about their care and treatment, and 80% said their regular doctor explained things ‘in a way that is easy to understand’ (Figure 3). Several countries have seen small decreases in positive responses to these questions since 2013. However, the UK has seen comparatively larger decreases over time, with the biggest being in the number of people who said their regular GP spends enough time with them, which fell from 85% in 2013 to 58% in 2023. 

Care coordination

Another area where the UK performed poorly compared with other surveyed countries was the coordination of care and flow of information between primary and secondary care. Among UK patients with a regular GP, just under half (49%) agreed that someone in their doctor’s practice ‘always’ or ‘often’ helped to coordinate the care they receive from other doctors and places (Figure 4). Among UK respondents who needed specialist care in the previous 2 years, 31% said their regular GP did not seem informed and up to date about the specialist care they received, a higher proportion than all countries except Australia and France. The UK performed better on medications review, with 69% of people who took at least two prescription medications reporting that their medicines had been reviewed in the last 12 months by any health care professional, ranking the UK around the middle range for this question. 

Hospital and specialist care

Access .

50% of people in the UK reported seeing, or needing to see, a specialist in the last 2 years. This is similar to responses from Canada, the Netherlands, New Zealand and Sweden, while Australia, France, Germany, Switzerland and the US had considerably higher proportions, with 59% to 77% of respondents answering ‘yes’ to this question. People in the UK also reported fewer hospitalisations than some countries, with 15% having an admission to hospital for at least 1 night in the past 2 years, lower than Australia (24%), France (22%) Germany (25%), New Zealand (20%) and Switzerland (19%). Meanwhile, 14% of people in the UK reported having non-emergency or elective surgery in the past 2 years. This is similar to Canada, France, Germany, Sweden and Switzerland but lower than the remaining countries, except the Netherlands (10%).

Despite comparatively lower reported use of specialist services than other countries, the UK had among the longest waiting times for a consultation with a specialist. Of those who needed to see a specialist within the past 2 years, 37% reported getting an appointment within 1 month (Figure 5, slide 1). Only Canadians reported a lower percentage (31%). Meanwhile, Australia, Germany, the Netherlands, Switzerland and the US performed better, with 46% to 64% of respondents reporting being seen within 1 month. 

The UK ranks slightly below average on the percentage of people seen within 1 month for non-emergency and elective surgery (31%) (Figure 5, slide 2), with the Netherlands (58%), Germany (50%), Switzerland and Australia (both 44%) and the US (39%) performing better. 

The UK also stands out for having more people in the longest categories of waiting times. In the UK, 11% of people waited 1 year or more for a specialist appointment, and 19% waited 1 year or more for non-emergency or elective surgery. Canada is the only country experiencing comparable waits, with 9% of people waiting a year or more for a specialist appointment and 20% waiting a year or more for non-emergency or elective surgery. 

Finally, while waiting times have been increasing in every country over the past decade, waiting times have increased most rapidly in the UK, from a low of 14% of respondents waiting more than 4 weeks for a specialist appointment in 2013 to a high of 61% in 2023 (Figure 6). 

Emergency care

Levels of reported emergency department use in the UK are around the average of the surveyed countries. 34% of people in the UK said they had used A&E at least once ‘for their own medical care’ in the preceding 2 years. Among those who attended A&E in the past 2 years and have a regular GP or GP practice, 31% said their medical issue could have been treated by their regular doctor if they had been available. This proportion is similar to most countries, with Canada and the US performing worse (38% and 41%, respectively). The number of UK respondents who have used A&E in the past 2 years has increased by 10% since 2016, while the proportion of A&E visits treatable by a regular doctor has remained around the same since 2013.

Patient experience 

Respondents who were hospitalised overnight in the past 2 years were also asked about their experiences of hospital care. The UK was close to the average in ensuring patients are treated with respect by nurses (88%), ensuring all prescribed medications are reviewed before a patient leaves hospital (77%) and patients feeling included in decisions about their care and treatment (83%), although New Zealand, Sweden and Switzerland performed significantly better on the latter (Figure 7). After leaving hospital, the majority of UK respondents (71%) said follow-up care with a doctor or other health professional was arranged for them. While this was less than in 2013 (81%), this percentage was similar to other countries surveyed, with only Germany (57%) and Sweden (62%) performing worse, while Canada performed better (77%). 

Reported problems with the coordination of medical information in primary care in the UK were mirrored in specialist care and hospitals. The UK performed worst on the proportion of patients reporting that their specialist doctor or consultant did not have access to information or tests results from their regular doctor (22%), compared with the best performing, the Netherlands (10%). Overall, 39% of UK respondents who needed to see a specialist or consultant in the past 2 years experienced a coordination problem between primary and secondary care, or vice versa, the highest proportion of any surveyed nation.

Financial protection

The survey explores whether people face cost-related barriers to a range of health care services. People in the UK reported below average cost-related barriers for prescription medicines, consultations with a doctor and follow-up treatments (Figure 8), and well below the US, which has the largest barriers in most domains. Nevertheless, cost-related problems have grown significantly in the UK since 2013 (Figure 9), with financial barriers to dental care increasing more rapidly relative to other categories. Problems with costs for dental care are common across countries: the UK still ranks among the average for dental care cost barriers, with 26% of UK participants saying they had skipped dental check-ups and treatment because of the cost. New Zealand (44%), Australia (40%), the US (37%) and Canada (31%) report significantly larger proportions of respondents skipping dental care due to cost. 

Cost barriers for prescription medicines vary among nations within the UK: Scotland and Wales abolished prescription charges in 2011 and 2007, respectively. This was mirrored in the survey, with respondents in England significantly more likely to skip collecting a prescription because of cost (8%) compared with those in Wales (1%) and Scotland (2%). 

The results of the 2023 survey confirm many of the known challenges facing the NHS across the UK, especially pressure on general practice and hospital services. They also flag that some of these pressures are not unique, also existing in other health systems. The UK’s results suggest some areas of strength compared with other countries. In this section, we draw out some of the implications of the survey, primarily for England, but also for the UK where data permit.

General practice

On the more positive side, the UK still ranks highly in the proportion of people who report having a regular GP practice (97%). Having a regular GP practice is considered a fundamental building block of primary care: in countries with low or falling percentages of people with a regular GP practice, for example the  US or  Canada , experts worry that the health system will struggle to effectively prevent, diagnose and treat disease early, or manage chronic disease, as a result. 

The UK also performs well compared with many countries on the proportion of people reporting that they can get an appointment on the same or next day (42%). For England, this is broadly consistent with other sources of evidence, including  GP activity data (which show that 52% of GP appointments happen on the same day or day after someone contacts the practice) and the  2023 GP Patient Survey (which found that 44% of patients were seen on the same or next day after trying to book an appointment). 

Other responses underline the severity of the pressures on general practice. The UK stands out for difficulties getting a same-day answer for a medical problem. While not all queries need a same-day response, the results of this survey are similar to those of the 2023 GP Patient Survey for England, suggesting increasing problems for patients in making contact with their practice. For the first time since 2012,  more patients said it was difficult to get through to their practice on the phone than said it was easy (and over 80% of patients still use the phone to book appointments). Difficulties contacting a GP practice were also reflected in the most recent national surveys in  Scotland and  Wales .

The survey findings suggest that the pressures on general practice are also being felt once patients get an appointment. The UK tended to score poorly compared with other countries on questions about one’s GP spending sufficient time with them, explaining things in ways that are easy to understand and involving them in decisions about care and treatment. 

The backdrop to these results is well known. In England, the volume of GP appointments needed is at record levels but the number of full-time, fully qualified GPs has fallen since 2015, as has the proportion of overall NHS funding going to  primary care . Recent  government policy has prioritised making it easier for people to contact their practice (for example through better telephone systems) and increasing the number of available appointments, particularly through increasing non-GP staff. But there are concerns that these policies – primarily aimed at increasing the ‘supply’ of appointments – may be at the expense of other important dimensions of general practice, for example the importance of continuity of care, which is linked to  better outcomes and may be more  efficient in the long run.

As with our  2022 survey of GPs , this latest survey found there are significantly more general practice appointments taking place by phone (or video) in the UK than in many other countries. In England, the pandemic led to a rapid switch to  virtual GP appointments , and the proportion of GP appointments that were face-to-face fell to 36% at its lowest in April 2020. In 2021, the government  urged GP practices to increase face-to-face appointments. The proportion of face-to-face appointments has increased relative to virtual appointments but remains below pre-pandemic levels. Although GP practices are still  criticised in the media for over-reliance on virtual appointments, this survey suggests that most people (75%) were satisfied with virtual consultations, similar to  other studies . The  OECD has noted significant variations in the degree to which countries switched to remote consultations during and after the pandemic and has encouraged systematic collection of data on their value and accessibility to people from all demographic groups. 

Improving access and quality in general practice is a priority for governments across the UK, but other countries also face challenges in primary care. Many countries in Europe have shortages of general practitioners and are  developing policies to increase the supply of GPs, especially in more rural and remote areas. The  OECD has also identified weaknesses in primary care across nations – including poor coordination, inefficient use of staff skills and not enough focus on prevention – that need to be rectified as countries face the challenge of ageing populations with more chronic illness and rising health system costs. 

Hospital and specialist care 

The survey confirms known pressures on the UK hospital system. In England,  monthly attendance at all types of A&E was 2.32 million in July 2024, 6% higher than in 2023, and all four countries of the UK have seen  longer waits for emergency care since 2013. The causes of higher attendance at A&E are complex:  difficulties accessing general practice are likely to be only one factor (others include seasonal illnesses, the residual impact of COVID-19 and growing levels of complex health conditions associated with an ageing population). In this survey, a third of people who used A&E thought their problem could have been treated by their regular doctor if they had been available, but the survey did not ask why the GP was unavailable, for example because it was out of hours. In England, the GP Patient Survey found that 12.2% of patients who got through to their GP but were either not offered an appointment or were unable to take the offered appointment attended A&E instead. In England,  current policy aims to increase the capacity of urgent and emergency care outside hospitals, including NHS 111.

The UK also stands out for long waits for specialist care and elective procedures. This survey suggests that the proportion of people waiting more than 4 weeks to see a specialist has slowly risen in all countries since 2013, but the UK has gone from being one of the best performing countries to the worst (alongside Canada) for reported waits of over 1 year for a specialist or consultant appointment. 

Almost without exception, health systems across the world experienced disruptions to hospital services in 2020 and 2021 as a result of the pandemic. The OECD estimated that 2 million fewer elective surgeries took place in 23 European countries in 2020 than in 2019, with backlogs common. A 2022 analysis of European countries by the WHO found that some health systems had successfully reduced these backlogs, but noted that this was harder in places with low numbers of health care workers pre-COVID or less financial capacity to increase supply. 

The UK has spent less per head on health care over the past decade than many comparable countries with shorter waits, such as Germany. But Canada and Sweden also experience problems with long waiting times that precede the pandemic. Both spend more per capita on health care than the UK . In England, current policy to reduce waiting times for elective care includes many of the strategies used by other health systems: using target waiting times, increasing the supply of staff and financial incentives for providers. But historically low levels of investment in NHS buildings and equipment compared with other countries, combined with the lingering impact of COVID-19, likely contribute to the slow progress in reducing long waiting times in the UK. 

In previous comparisons of international performance by the Commonwealth Fund , based on the International Health Policy Survey and OECD data, ‘affordability’ of health care for patients is a key attribute of a high performing health system, and an area in which the UK has ranked highly over several years . Analysis of household survey data (from 2018 and 2019) by the WHO also finds that the UK has some of the lowest levels of ‘impoverishing’ or ‘catastrophic’ household spending on health care in Europe.

In this survey, although the UK still has smaller proportions of people reporting cost barriers to accessing doctors, tests or treatments than some other countries, these percentages have risen slightly in recent years and are of concern in a health system that is predominantly free at the point of use. In England, a series of Healthwatch surveys between October 2022 and March 2023 (a period of high inflation) found that 11% of people had avoided making a health care appointment because of the cost of a call or internet access, and a similar proportion had avoided attending appointments because of the cost of travel. These challenges are likely to have compounded the disadvantage faced by those on low incomes who live in deprived areas , where rates of ill health and the need for health care are higher and the number of GPs is likely to be lower .

In England, higher proportions of people reported not collecting medication or skipping doses because of the cost compared with respondents in Scotland, Wales and Northern Ireland, where prescription charges have been removed. Although a range of exemptions are in place in England, for example for people aged 60 years and older or people with certain health conditions, advocacy groups have argued for free prescriptions for all people with long-term conditions and say financial pressures are causing worse health among those who cannot afford their medication.

Compared with other medical services, UK respondents reported the highest proportion of cost-related barriers to dentistry, with many other countries experiencing similar problems. These problems are likely linked to both user charges for NHS dental treatment and a shrinking proportion of dental practices offering NHS treatment, a trend in all four countries of the UK. In the 2023 British Social Attitudes survey , more people reported being ‘very dissatisfied’ with NHS dentistry (28%) than any other NHS service. 

A lack of accessible and affordable dental care is not unique to the UK. A study of dental care in European countries found that on average more than half of dental care spending is out of pocket, and dental care is the most common type of care people go without for financial reasons. Countries with more comprehensive public insurance cover (for example Germany) or with affordable voluntary health insurance (the Netherlands) have lower unmet needs for dental care. 

This survey reveals the extent of pressures on the NHS. On many indicators, the UK ranks among the lower performers, especially in relation to waiting times for hospital services and some aspects of primary care. While no health system consistently outperformed others in this survey, many of the countries where people reported shorter waiting times and easier access to services have higher levels of spending, though higher spending does not deliver better performance in all cases.

In England, the new government has been blunt about the poor state of health services. It has pledged to investigate the causes before setting out its plans to remedy them. Alongside reforms to improve responsiveness and productivity, any long-term solution will also need sustained, additional investment in services and capital if the NHS is to regain ground compared with other health systems. 

About the Commonwealth Fund’s 2023 International Health Policy Survey of the General Population in 10 Countries

The Commonwealth Fund provided core funding, with co-funding or technical assistance from the following organisations: the Canadian Institute for Health Information; Commissaire à la santé et au bien-être du Québec; Ministère de la Santé et des Services sociaux; Ontario Health; La Haute Autorité de Santé; German Ministry of Health and the Robert Koch Institute; Stichting Radboud universitair medisch centrum (Radboud University Medical Center); the Swedish Agency for Health and Care Services Analysis (Vård- och omsorgsanalys); the Swiss Federal Office of Public Health; and The Health Foundation.

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Press release - 21 August 2024 13:53

Northumbria University set to host the Royal College of Nursing’s International Nursing Research Conference 2024

Northumbria University will host the Royal College of Nursing’s International Nursing Research Conference for 2024 at its Newcastle City Campus.

Held over three days between Tuesday 10 and Thursday 12 September the conference will bring together hundreds of individuals with an interest in nursing, health and social care research and aims to improve nursing practice through learning, networking, discussion and debate around the challenges facing the future nursing workforce.

This year the event titled ‘Inclusivity in Nursing Research: Working Together to Make a Difference’, is specifically aimed at showcasing research that addresses the needs of under-served populations and celebrating research that uses innovative designs to facilitate the inclusion of all stakeholders.

The programme will feature research from professionals across the world who are dedicated to developing and informing nursing practice through new knowledge, understanding and collaboration.

The event will see a host of keynote speakers take to the stage to present, including Clinical Academic Professor of Nursing at Northumbria University and Newcastle upon Tyne Hospitals NHS Foundation, Professor Annette Hand , who will present on ‘Informal Carers – the under-represented member of the multidisciplinary team’.

Professor Carl May, Professor of Health Systems Implementation at the London School of Hygiene and Tropical Medicine, UK will open the conference with his keynote on ‘Fighting Inequalities Through Better Intervention and Service Design’.

In addition, there will also be keynote presentations from:

• Professor Roxanne Crosby-Nwaobi from the Moorfields Eye Hospital and the University College London Institute of Ophthalmology will be examining key issues of racism and gender inequity as a nurse researcher, her talk will be titled ‘Nursing whilst Black: Trials, Tribulation and Successes in Research’.
• Professor Rhonda Wilson, Professor of Mental Health Nursing from RMIT University, Australia will explore ‘Culturally aligned methods and models for priority populations’.
• And, Dr Linda Tinkler, Trust Lead for Nursing, Midwifery and Allied Health Professionals Research at Newcastle Upon Tyne Hospitals NHS Foundation Trust will deliver her keynote on ‘Communicating for success in clinical research regardless of your role’.

Dr Barbara Farquharson, Conference Chair said: “We are delighted to be hosting our annual International Nursing Research Conference in collaboration with Northumbria University, Northumbria Healthcare NHS Foundation Trust and Newcastle upon Tyne Hospitals this year. Inclusivity needs to be paramount in all that we do – with our communities, patients and nursing workforce.

“Over the three days of the conference we will welcome speakers and delegates to showcase the research that will impact and influence the future of nursing education, research, policy and practice.”

Prof Jane Ball, Director of the RCN Institute of Nursing Excellence said: “I’m looking forward to welcoming nursing academics from around the world to what has always been a key event in my calendar, and to discussing the role that research – and the new Institute – can play in making the value of nursing evident to all.”

Worth 27 Continuing Professional Development (CPD) hours, the conference will cover topics including; research with under-served populations; research using inclusive methods or achieving true diversity; interdisciplinary research; clinical effectiveness and nursing research, evaluating change; patient experience and the role of research; health and social care policy research and the impact of research on nurse-sensitive outcomes.

The conference will see a whole host of esteemed national and international professionals, including several academics from Northumbria University, deliver presentations on their own areas of research over the three days. A full programme can be downloaded from the RCN event webpages .

For the first time in the conference’s history, day two of the event will also include specific sessions focusing on Clinical Research Nursing showcasing another area of nursing that has a huge impact on the lives and experiences of patients.

Speaking on hosting the event Professor Paul Gill , Professor of Nursing and Deputy Head of the Department of Nursing, Midwifery and Health at Northumbria University, said: “We’re delighted to be hosting this year’s RCN International Nursing Research Conference at Northumbria University.

“At Northumbria we are dedicated to continuously driving improvement across the profession, working to enhance education and training in nursing and helping to overcome the workforce challenges currently faced by the sector and research is a major part of how we can achieve those goals.

“The conference will bring together so many brilliant nurses and will provide an excellent platform for some big conversations about how we move the profession forward. We’re really looking forward to the event and showcasing Northumbria University and the region.”

For more information about the event or to book please visit the Royal College of Nursing’s website .

Northumbria University is dedicated to reducing health and social inequalities, contributing to the regional and national workforce and improving social, economic and health outcomes for the most marginalised in society. Through its new Centre for Health and Social Equity, researchers will be delivering world-leading health and social equity research and creating innovative, evidence-based policies and data-driven solutions to bring impactful change across the region, the UK and globally.    

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• Volume 14, Issue 8
• Recurrent patellar dislocation: personalised therapy or operative treatment? The REPPORT randomised trial protocol
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• http://orcid.org/0000-0001-8152-7610 Susanne Arnold 1 ,
• Aminul Haque 1 ,
• Manjit Aujla 1 ,
• Raegan Barrows 1 ,
• http://orcid.org/0000-0001-7884-6389 David Beard 2 ,
• Craig Chandler 3 ,
• Elizabeth Chandler 3 ,
• http://orcid.org/0000-0002-2992-048X David R Ellard 1 , 4 ,
• Jonathan Eldridge 5 ,
• http://orcid.org/0000-0002-3479-0683 Manuela Ferreira 6 ,
• Nadine E Foster 7 , 8 ,
• http://orcid.org/0000-0002-6364-0414 James Griffin 1 ,
• James Mason 1 ,
• Vipul Mandalia 9 ,
• http://orcid.org/0000-0002-2765-3728 Helen Parsons 1 , 4 ,
• Georgina Ray 1 ,
• Kimberley Stewart 1 ,
• Peter Thompson 4 ,
• http://orcid.org/0000-0002-0309-1708 Martin Underwood 1 , 4 ,
• http://orcid.org/0000-0003-2436-9024 Michael R Whitehouse 10 , 11 ,
• Mandana Zanganeh 1 ,
• http://orcid.org/0000-0002-4515-8202 Andrew Metcalfe 1 , 4 ,
• Toby Smith 1
• 1 Warwick Clinical Trials Unit , University of Warwick , Coventry , UK
• 2 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford , UK
• 3 Patient Representative , Norwich , UK
• 4 University Hospitals Coventry and Warwickshire NHS Trust , Coventry , UK
• 5 University Hospitals Bristol NHS Foundation Trust , Bristol , UK
• 6 Sydney Musculoskeletal Health, Faculty of Medicine and Health , University of Sydney , Sydney , New South Wales , Australia
• 7 STARS Education and Research Alliance , The University of Queensland and Metro North Health , Brisbane , Queensland , Australia
• 8 Keele University , Staffordshire , UK
• 9 Royal Devon University Healthcare NHS Foundation Trust , Exeter , UK
• 10 Musculoskeletal Research Unit , University of Bristol , Bristol , UK
• 11 National Institute for Health Research, Bristol Biomedical Research Centre , University Hospitals Bristol and Weston NHS Foundation Trust , Bristol , UK
• Correspondence to Professor Toby Smith; toby.o.smith{at}warwick.ac.uk

Introduction Recurrent patellar dislocation is a debilitating musculoskeletal condition, affecting mainly adolescents and adults under the age of 30. It can persist for many decades, causing pain and cartilage and soft-tissue damage, potentially leading to osteoarthritis. Recurrent patellar dislocation can be managed with physiotherapy or surgery. However, it is not known which treatment is most effective.

Methods and analysis Recurrent Patellar Dislocation: Personalised Therapy or Operative Treatment (REPPORT) is a pragmatic, multicentre, two-arm, superiority, randomised controlled trial. It will compare the clinical and cost-effectiveness of an initial management strategy of personalised, phased and progressive rehabilitation, termed personalised knee therapy versus surgery for recurrent patellar dislocation.

The trial’s target sample size is 276 participants who will be recruited from approximately 20 sites across the UK. Participants will be randomly allocated to the two treatment groups via a central computer-based minimisation system. Treatment allocation will be in a 1:1 ratio, stratified by age, presence of patella alta and recruitment site.

The primary outcome is participant-reported function using the Knee injury and Osteoarthritis Outcome 4-domain score at 18 months post randomisation. Health economic evaluation will be conducted from a healthcare system and personal social services perspective. Secondary outcome data including patellar instability, health utility, work/education status, satisfaction with social roles and treatment, health resource use and adverse events will be collected at 6, 12, 18 and 24 months. Analysis will be on an intention-to-treat basis and reported in-line with the Consolidated Standards of Reporting Trials statement.

Ethics and dissemination The trial was approved by the East Midlands—Nottingham 2 Research Ethics Committee on 30 March 2023.

Results will be disseminated via peer-reviewed publications, presentations at national and international conferences, in lay summaries, and using the REPPORT website and social media channels.

Trial registration number ISRCTN17972668 .

• TRAUMA MANAGEMENT
• Orthopaedic & trauma surgery
• Physical Therapy Modalities
• Randomized Controlled Trial

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https://doi.org/10.1136/bmjopen-2024-090233

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STRENGTHS AND LIMITATIONS OF THIS STUDY

This will be the largest randomised controlled trial (RCT) of the management of recurrent patellar dislocation.

This is a multicentre RCT recruiting participants from across England, Wales, Scotland and Northern Ireland which promotes National Health Service generalisability.

This is a non-blinded trial due to impracticability of blinding for rehabilitation.

There is a potential for discrepancy in time to intervention between the treatment arms due to differential waiting list durations.

Introduction

Recurrent patellar dislocation is a profoundly debilitating condition. It affects mainly adolescents and adults under 30 years. Recurrent dislocations can persist for many decades and cause pain, and cartilage and soft-tissue damage as well as long-term consequences for people’s health and well-being. 1–5 It is common for those affected to develop osteoarthritis in the affected joint, leading to long-term disability and greater need for health services. 4–6

First-time (primary) patellar dislocation affects up to 43 per 100 000 people with an estimated incidence of 147 per 100 000 among young females. 7–9 It is usually treated conservatively (non-surgical). There is increased risk of having a second (recurrent) dislocation within the first 5 years of a primary dislocation, occurring in approximately 40% of cases. 3 10 11 Recurrent dislocations result in ongoing restrictions and patient outcomes are poor. 10–13 Between dislocations, many of those affected report a feeling of instability or that their patella is about to dislocate. These problems can lead to activity modification, cause severe disruption to education, work and social or physical pursuits and have a major impact on quality of life as individuals try to avoid dislocations or instability symptoms. 3 14–17

Recurrent patellar dislocation can be managed with physiotherapy or surgery. There is uncertainty as to which strategy is best. 18–20 Currently, treatment decisions are based on the treating clinician’s opinion. 11 19 21 22 Some feel that without surgery, dislocations and restriction will persist or worsen as structures around the knee could be damaged. Others believe that physiotherapy is effective and avoids the discomfort, risks, recovery period and cost of surgery. 11 19

As well as impacting patients, recurrent patellar dislocation is also a burden on health services. In 2020, unpublished data from a collaborative study for the British Association for Surgery of the Knee reported 3639 cases from 45 National Health Service (NHS) Trusts over a 5-year period. Extrapolated to the whole NHS, the data suggest around 2000 surgical cases are performed annually, costing approximately £5M.

There is no evidence from randomised controlled trials (RCTs) to determine the best practice in managing recurrent patellar dislocation. In 2019, we completed a mixed-method feasibility RCT (Patellar instability: Physiotherapy vs Surgery (PIPS)) across three NHS sites comparing a bespoke personalised knee therapy (PKT) intervention versus surgery with postoperative rehabilitation for recurrent patellar dislocation. 23 The aim was to determine the feasibility of conducting an RCT in the recurrent patellar dislocation population, including recruitment strategies, retention of participants, clinician and participant equipoise, and data collection methods. The feasibility RCT highlighted numerous challenges requiring a series of changes to ensure adequate recruitment and follow-up. When implemented, the revised trial design was found to be a feasible model to deliver a full trial. 23

To determine the best practice for people presenting with recurrent patellar dislocation, a definitive RCT is needed. Here, we summarise the protocol for Recurrent Patellar Dislocation: Personalised Therapy or Operative Treatment (REPPORT); an RCT comparing the decision to offer physiotherapy or surgery as a primary treatment strategy for recurrent patellar dislocation.

Aims and objectives

The aim of the REPPORT trial is to determine whether an initial management strategy of PKT or surgical care is the most clinically effective and cost-effective approach for people with recurrent patellar dislocation (two or more dislocations in the same knee).

Methods and analysis

Trial design.

REPPORT is a pragmatic, multicentre, two-arm, superiority, RCT comparing the clinical and cost-effectiveness of PKT (non-surgical care) versus surgery. The trial is powered to test superiority but with equipoise between intervention arms. REPPORT is funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (HTA project: NIHR134398). The trial opened to recruitment in August 2023 and expected end date is December 2027.

This protocol paper was written following the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. 24 Figure 1 shows the participant flow diagram. The participant consent form is presented in online supplemental file 1 . A summary of core trial information is presented in the WHO trial registration data set ( online supplemental file 2 ). 25

Supplemental material

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Recurrent Patellar Dislocation: Personalised Therapy or Operative Treatment (REPPORT) participant flow diagram. KOOS4, Knee injury and Osteoarthritis Outcome 4-domain score; PKT, personalised knee therapy.

Patient and public involvement

Patient and public involvement (PPI) has been critical in designing and developing the trial and will continue to be important in its delivery and dissemination of results.

We have engaged with a PPI group who have had treatment (surgery and physiotherapy) for patellar dislocation to learn more about their experiences but also to get their input into our trial design and development of patient facing materials. Two of these PPI representatives are coapplicants on the trial’s research team and this manuscript. Our PPI coapplicants are integral to the Trial Management Group (TMG), attending trial management meetings, contributing the patient perspective to trial processes, procedures and documentation. They will be key to our dissemination plan. Two further PPI representatives sit on the Trial Steering Committee (TSC).

Primary objectives

To compare the clinical effectiveness of PKT versus surgery, based on participant-reported function, 18 months post randomisation, using the Knee injury and Osteoarthritis Outcome 4-domain score (KOOS4).

To compare the cost-effectiveness of PKT versus surgery from an NHS and personal social service (PSS) perspective.

Secondary objectives

To quantify and draw inferences on function, pain, instability, number of dislocations, health utility, work or education status, satisfaction with social roles, resource use, further surgery and adverse events (AEs) at 6, 12, 18 and 24 months.

To evaluate process measures to compare days from randomisation to treatment initiation, and PKT and postoperative rehabilitation attendance and adherence.

Outcome measures

Outcome measures were selected in collaboration with our PPI representatives and our experienced clinical team. In-line with SPIRIT guidance, 24 details of the schedule of enrolment, interventions and assessment are presented in online supplemental file 3 .

Primary outcome

The primary clinical effectiveness outcome is participant-reported knee function using the four domain KOOS4 score 18 months post randomisation. This is a 25-item knee-specific instrument (0–100; 100 best score) which sums four of the five domains of the full KOOS score (the domains for symptoms, pain, function/sports and quality of life, but not activities of daily living). 26 It has been widely used in previous trials in knee surgery, including young adult non-arthritic populations such as this one, and is well-accepted by clinicians. 27–31

A prospectively planned economic evaluation will be conducted from an NHS and PSS perspective, according to the recommendations of the National Institute for Health and Care Excellence (NICE) reference case. 32 Bespoke resource utilisation questions about health service and social service contacts made in connection with the participant’s treatments, as well as time lost from work (paid/unpaid), will be incorporated into participant questionnaires.

Secondary outcomes

All collected at baseline, 6, 12, 18 and 24 months. Given there may be a differential wait for the intervention between arms, we will also collect KOOS4 and EQ-5D-5L from all participants within 4 weeks before the start of their allocated intervention.

The five individual KOOS domains (symptoms, pain, activities of daily living, sports, quality of life). 26 33

Norwich Patellar Instability score. 15 A validated tool used to assess perceived patellar instability.

Health utility (EQ-5D-5L and EQ-VAS). 34 35 The EQ-5D-5L is a validated measure of health status consisting of five dimensions each with a five-level answer possibility.

Work or education status (time off, change to status).

Satisfaction with social roles (Patient-Reported Outcomes Measurement Information System (PROMIS) scale). 36

Satisfaction with treatment using a five-point Likert scale. 37

Patient Global Impression of Change scale (single item). 38 This is a simple 7-point scale assessing perception of improvement.

Self-reported patellar dislocation events.

Further knee surgery and/or physiotherapy (either arm).

Health resource use.

Safety outcomes

AEs and serious adverse events (SAEs) related to the surgical procedure including the surgery, anaesthetic, postoperative care and rehabilitation, any component of the PKT programme or any knee treatment in the reporting period will be collected according to relevant Warwick Clinical Trials Unit (WCTU) Standard Operating Procedures (SOPs) from the point of randomisation until 24 months.

Process and fidelity measures

Days from randomisation to treatment initiation.

PKT and surgical case report forms (CRFs) plus postoperative physiotherapy CRFs to assess intervention fidelity including information on:

Number of PKT sessions offered and attended.

Composition of PKT.

Details of surgery including surgical procedure, surgical findings, theatre time, tourniquet time and any other procedures.

Number of postoperative physiotherapy sessions offered and attended.

Composition of postoperative physiotherapy.

Eligibility criteria

Inclusion criteria.

Experienced at least two (self-reported) lateral patellar dislocations affecting the same knee.

Age 16 years or over at trial entry.

Exclusion criteria

Open growth plates on standard care imaging (typically but not restricted to MRI).

Presence of another knee condition which may cause instability (eg, cruciate ligament instability, unstable meniscal tear).

Previous patellofemoral surgery, except simple arthroscopy with/without lateral release.

Severe trochlea dysplasia which, in the opinion of the treating clinician, requires trochleoplasty.

Malalignment of femur or tibia requiring corrective osteotomy (not including tibial tubercle osteotomy (TTO)).

Osteochondral/chondral injury requiring surgery, except removal of loose body.

Medial patellar dislocation or dislocations when the knee flexes (ie, the patella is located in extension and dislocates every time the knee flexes).

Previous randomisation into the trial (ie, the other knee).

Unable to have either physiotherapy or surgery.

Unable to adhere to trial protocols or complete questionnaires.

Extra detail was added to the exclusion criteria after commencement of the trial. Unable to have either physiotherapy or surgery was added and approved by East Midlands—Nottingham 2 Research Ethics Committee (REC) on 22 August 2023 and additional detail about removal of loose bodies 6 and dislocations when the knee flexes 7 were approved on 12 January 2024.

Participant identification, screening and withdrawals

Participants will be identified by clinical teams predominantly from NHS orthopaedic departments and acute musculoskeletal services (such as injury review clinics). Depending on individual site contexts, potential participants could also be recruited from NHS emergency departments or physiotherapy services.

Eligibility will be assessed by routine clinical evaluation, with no requirement for any trial-specific investigation by an appropriately delegated clinician. Screening data will be entered directly on to the trial database.

Potential participants who are eligible will be given verbal and written information (either in person, by post or email) about the trial and invited to discuss it further with a member of the research team. They will be given adequate time to consider participation. A delegated member of each local research team will obtain informed consent from each participant, collecting either written consent or witnessed remote verbal consent and they will also collect baseline data.

Information sheets, invitation letters and other approved patient-facing materials including follow-up questionnaires may be posted, emailed, physically provided or shared via online links to participants.

Randomisation

Participants will be randomly allocated to the two treatment groups via a central computer-based minimisation system provided by WCTU’s programming team, independent of the study team. This will be performed after consent has been obtained and baseline data have been collected.

Treatment allocation will be in a 1:1 ratio using a minimisation procedure with a random factor of 70%, stratified by age group (<22/≥22 years), site of recruitment and presence of patella alta in the study knee (defined as yes/no by the presence of either a Biedert patella-trochlea overlap ratio <0.25 on cross-sectional imaging or Caton-Deschamps >1.2 on lateral radiograph/other routine clinical imaging). 39–41

Randomisation will be performed by any delegated member of the local clinical or research team, using the online system. Randomised participants can choose to discontinue their treatment and/or withdraw from follow-up at any time, without prejudice. This will have no effect on their current or future care. All withdrawals will be monitored by the TMG and oversight committees.

Trial treatment(s)/interventions

Group 1: pkt.

The PKT programme is based on the intervention developed for the PIPS feasibility RCT. 23 It was refined following a consensus meeting held in March 2023, whereby 12 experts in patellofemoral disorders and management convened to finalise a comprehensive evidence-based, phased, progressive, PKT programme for the trial, ensuring it is deliverable across all NHS sites. A template for intervention description and replication checklist 42 for the REPPORT PKT intervention is presented as online supplemental file 4 .

To work with the participant to reduce pain and swelling, optimise knee range of motion, improve lower limb strength, stability and function and improve confidence by addressing fear avoidance and maladaptive health beliefs, with the overarching aim of functional restoration to activities meaningful to the participant, that is, work, college/education, sports and recreational pursuits.

Delivered by

Physiotherapists trained in the principles of the REPPORT PKT programme. Training includes a background to the problem of recurrent patellar dislocation, the rationale for the trial, an overview of the PKT framework and phased programme, and trial documentation. Trained physiotherapists receive a REPPORT PKT manual containing a detailed account of trial and intervention procedures.

Mode of delivery

The intervention will be personalised to the participant, allowing for flexibility for PKT to be delivered face-to-face (either individually or in groups) in acute hospital or community physiotherapy departments, through virtual consultations, or a hybrid of the two.

Minimum of 3 months from first assessment incorporating up to six sessions. However, participants can be discharged earlier if they have achieved their treatment goals or extend their treatment as clinically required, reflecting normal clinical practice. Attendance to no physiotherapy visits will be considered non-compliance with PKT. Attendance at one to three sessions of PKT and goals not met will be considered as partial compliance. Attendance at four or more sessions or less than four session with goals met will be considered full compliance. This detail will be recorded on the PKT CRF.

Treatment starting point from randomisation

When an appointment with a physiotherapist is available in accordance with normal NHS service waiting times.

Timing of consultations

The interval between consultations will be personalised to the needs of the participant, based on their progress, presentation and treatment goals.

Initial assessment will include participant’s history (subjective assessment) and physical examination (objective assessment). This will follow a routine musculoskeletal physiotherapy assessment and will be used to determine which phase of treatment the participant commences the PKT programme. The PKT programme has three phases (A, B and C). These are framed on functional progression, based on objective criteria:

Progression from phases A to B requires the participant to have good range of knee motion and quadriceps strength with minimum pain and swelling.

Progression from phases B to C (return to sport and higher level function) requires the participant to have good proximal lower limb muscle control with rotational stability on multidirectional activities.

People who experience instability symptoms or recurrent dislocation can return to an earlier phase.

Based on individualised problems and goal setting, the intervention is aimed to specifically manage the participant’s presenting problems which are likely to include but not limited to knee pain and swelling, reduced knee mobility, reduced lower limb muscle length and strength, abnormal gait pattern, increased knee instability and fear avoidance or maladaptive health beliefs. This personalised approach aims to optimise rehabilitation outcomes. Treatments that could be offered include one-to-one or group-based exercise programmes plus adjuncts including thermal treatments, orthotics, taping and biofeedback as well as advice and education and behaviour modification techniques. Each participant will be given a manual including their specific treatment goals, information about their PKT programme with details of specific individualised exercises and an exercise planner to encourage self-monitoring and adherence.

Group 2: surgery with postoperative rehabilitation

Surgery will be performed according to published British Orthopaedic Association Standards for Trauma and Orthopaedics guidelines. 43 Based on established guidance and current reviews, the most widely recommended surgical treatment is medial patellofemoral ligament reconstruction, 44 whereby the gracilis or semitendinosus tendon is harvested and attached between the patella and the femur, using a screw in the femur. This typically involves three incisions of around 3 cm each. Complications are infrequent (approximately 3%–5%) and redislocation rates are between 2% and 5%. 45–48

Participants with patella alta (approximately 30%–50% of the recurrent dislocation population) 49 or where otherwise indicated may also undergo a simultaneous TTO, where the bony attachment of the patella tendon is cut and moved by approximately 1 cm. This involves an incision of about 8 cm and would typically be performed simultaneously with an MPFL reconstruction.

All care, including the choice of anaesthetic, the surgical procedure and postoperative analgesia, will be in accordance with usual procedures and care at participating sites.

Postoperative rehabilitation for the surgery group will be a programme based on the minimum standard of care consistent with normal NHS practice. The programme will start within the first 3 weeks after surgery and comprise lower-limb exercise-based rehabilitation from a physiotherapist with the aim of maximising postoperative recovery and functional restoration. Where possible, at each location, the physiotherapists delivering PKT will not deliver postoperative rehabilitation (and vice versa). Delivery of PKT and postoperative physiotherapy will be monitored via PKT and postoperative CRFs. A REPPORT PKT programme will not be used prior to surgery, but routine or current preoperative physiotherapy is permitted.

Participants randomised to surgery will be considered non-compliant if the operation does not occur. They will be partially compliant if they have the operation but no postoperative physiotherapy sessions and fully compliant if they have their surgery and one or more postoperative physiotherapy sessions.

End of trial

The trial will end when analysis of 24-month follow-up data is completed. This will be extended if funding is received for 5-year or 10-year follow-up (we will obtain participant consent for long-term follow-up at baseline).

The trial will only be stopped early if mandated by the REC or sponsor; following recommendations from the Data Monitoring Committee (DMC) to the TSC, or the TSC independently; or if funding for the trial ceases.

Safety reporting, AEs and SAEs

All AEs and SAEs will be defined using widely accepted standard criteria. For this trial, AEs and SAEs will be collected from the point of randomisation up to 24 months. To avoid unnecessary reporting, some events which occur during the interventions will be considered normal aspects of therapy, anaesthetic, surgery and postoperative recovery, unless in the opinion of the clinical team, they are untoward, excessive or outside of what might normally be expected; these will not need reporting. We will only collect AEs and SAEs related to the participants’ knee, treatment they receive in the trial (or any treatment for the study knee) or trial processes.

SAEs will be reported to WCTU within 24 hours of research staff becoming aware of the event. These will be followed up until they are resolved, or until the end of the trial, and an outcome has been agreed.

Statistical analysis

Power and sample size.

We performed a scoping review of papers reporting KOOS4 in patellar dislocation and used the method outlined by Chen et al 50 to calculate an estimate of the SD. This identified 10 studies (non-surgical and surgical treatment) from which the 80th centile of the SD was determined to give a conservative estimate of 21. Based on our feasibility RCT and data from other orthopaedic studies within our unit, we assumed that follow-up data are correlated with those collected at baseline (within person similarity). We conservatively estimate the correlation coefficient (ρ) as 0.5 for the KOOS4 at 18-month follow-up. By explicitly including this adjustment in the sample size calculation, we reduce the effective SD from 21 to 18.2.

We anticipate that there will be some treatment switching between allocation groups in this pragmatic trial. Hence, the choice of target difference should reflect any potential dilution of the observed treatment effect in the primary intention-to-treat (ITT) analysis. Therefore, reducing the between-group target difference in KOOS4 score from 10 to 8 points (an effect size of 0.44) represents an important worthwhile difference for this design and population.

For a two-group parallel arm design, 90% power and 5% significance, we require data on 110 participants in each group, allowing for an anticipated 20% loss to follow-up results in a target sample size of 276 participants. In this trial, each site will contribute small numbers and inflation for clustering is not necessary.

Statistical analysis plan

A comprehensive statistical analysis plan will be agreed with the DMC prior to any formal analysis taking place. All analyses will be reported inline with Consolidated Standards of Reporting Trials guidelines and WCTU SOPs. 51 52 Descriptive statistics will be constructed for baseline data to check for any characteristic differences between allocation groups.

The primary outcome will be analysed on an ITT basis and in-line with the trial’s superiority design; although no direction is stated, either is feasible and powered for. A generalised linear model will be used to assess differences in the KOOS4 score between treatment groups at 18 months post randomisation. At a minimum, the model will include terms for allocation, age, sex, recruitment site, presence of patella alta and baseline KOOS4 score. If other important baseline variables are identified, they may be fitted as appropriate. Random effects models will be used, with a random effect for recruitment site. Secondary outcomes will be analysed using a similar approach as appropriate to data and distribution. Categorical outcomes will be analysed with similar structure of models but with proportional logistic regression models.

Prespecified subgroup analyses will be undertaken to explore whether the intervention effect differs between: age group (<22 or ≥22 years) and presence of patella alta (yes/no). The subgroup analyses will follow the methods described for the primary analysis, with additional interaction terms incorporated into the mixed-effect regression model to assess the level of support for these hypotheses. The trial is not powered to formally test these hypotheses, so they will be reported as exploratory analyses only.

Primary inferences will be drawn from the models outlined under the ITT principle for the trial intervention of the initial treatment strategy . However, treatment switching is an important consideration in this trial and other analysis populations will be used for exploratory analysis. An ‘as-treated’ population, defined by the actual treatment received (ie, those who underwent surgery and those who adhered to PKT), will be conducted. Per-protocol analysis, restricted only to participants who adhere to protocolised treatment, will also be conducted to assess impact of protocol non-adherence. The results of any exploratory analysis in non-ITT populations will be interpreted with caution because bias from confounding can be introduced by moving participants from their randomised group. 53 Missing data will be scrutinised, and if deemed necessary, accounted for using multiple imputation methods.

All data will be entered and stored in a bespoke database management system developed by the programming team at WCTU. This is supported by a detailed Data Management Plan produced in accordance with WCTU SOPs to ensure high-quality data collection throughout the duration of the trial.

Health economic evaluation

A prospectively planned economic evaluation will be conducted from an NHS and PSS perspective. Health service contacts, made in connection with their interventions and time lost from education and/or work (paid/unpaid) at 6, 12, 18 and 24 months, will be recorded as part of the resource utilisation questions. Intervention and sequelae healthcare resource use will be costed using most recently available UK published national reference costs, reflated to a common year. 54 55

Health-related quality of life will be assessed using the EQ-5D-5L. 34 These scores will be converted to health status scores using the UK value set recommended by NICE guidance at the time of analysis. 56 The area-under-the-curve health status scores will be calculated using the trapezoidal rule, providing patient-level quality-of-life years (QALYs) estimates.

If missingness of patient-level costs or QALYs ≤5%, the primary analysis will use complete case data. 57 If missingness exceeds 5%, mechanisms of missingness of data will be explored and multiple imputation methods will be applied to impute missing data. Complete case data or imputation sets will be used in bivariate analyses of costs and QALYs to generate within trial incremental cost per QALY estimates and CIs. 58–61 Findings will be analysed and visualised as cost-effectiveness acceptability curves, net monetary benefit and value of information analysis. Prespecified sensitivity analysis will be used to explore the robustness and generalisability of findings.

The within-trial analysis will serve as the primary analysis under several conditions reflected in the pattern of incremental costs and QALYs over the 24-month follow-up: if these converge (no longer-term difference between interventions) or if they diverge such that either PKT or surgery are clearly dominant (with further extrapolation uninformative). If further modelling is likely to be informative, then the modelled finding will form the primary analysis. We will develop a decision analytic model, using our expertise in economic modelling in knee surgery. 62–64 The probabilistic model is likely take the form of a Markov model, capturing subsequent surgery including primary and revision knee replacement over the life course, with parameters drawn from published sources. 65 66 Reporting will follow the Consolidated Health Economic Evaluation Reporting Standards statement. 67

Ethics and dissemination

The trial was approved by the East Midlands—Nottingham 2 REC on 30 March 2023 (23/EM/0075). The REPPORT trial will adhere to the Declaration of Helsinki and Good Clinical Practice principles, complying with all relevant WCTU SOPs. Participants will provide informed consent before agreeing to take part. An independent DMC and TSC will provide oversight from set-up to the end of the trial. Both committees will comprise independent members as per the NIHR and WCTU SOPs requirements. Members will sign separate committee charters. Protocol amendments will be disseminated to sites by the trial coordinating team.

Data Sharing

De-identified data underlying the trial results will be available for non-commercial use, up to one year after publication of the trial findings, or from metadata stored in a university repository up to 10 years without investigator support. To access trial data, third parties must complete a data-sharing agreement with the sponsor, have an ethically approved protocol in place for use of the data, and agree the approved protocol with the REPPORT TMG and WCTU Data Sharing Committee. Data may be used for commercial purposes, according to the conditions above, but will need specific agreements in place prior to access being agreed, and may include a license fee. Analyses may include individual patient data meta-analyses or other purposes as agreed with the REPPORT TMG. Available data will include (but is not exclusive to) de-identified individual participant data, the trial protocol, SAP, master copy of the informed consent sheets and scripts or files used to conduct trial analyses.

Trial registration and study timelines

The trial is registered with the ISRCTN register ( ISRCTN17972668 ). The current version of the protocol is V4.0, approved on 15th January 2024. The planned timeline of the trial is from January 2023 to December 2027.

Dissemination and publication

Results will be shared with trial collaborators and the main results paper will be drafted by the trial team and agreed by the TSC prior to submission to a major peer-reviewed journal. Summary briefing papers, press releases and social media posts will be prepared for the wider community with specific input from our PPI team. These outputs will allow for the results to be disseminated across the orthopaedic and rehabilitation communities, the wider medical community, policy makers and patients and society at large in the UK, and globally. Dissemination to trial participants will follow current Health Research Authority (HRA) guidelines, with summaries available on the REPPORT website and social media channels.

Ethics statements

Patient consent for publication.

Not applicable.

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Contributors AM and TS are co-chief investigators and main grant holders for the REPPORT trial. TS is also the guarantor. Alongside the following coapplicant grant holders: DB, DRE, JE, MF, NEF, JG, JM, VM, HP, PT, MU and MRW, AM and TS designed and produced the main REPPORT trial protocol. Their expertise includes orthopaedic surgery, physiotherapy, statistics, health economics and clinical trial methodology. All of these authors contributed to the planning and drafting of this manuscript and gave approval of the final version. CC and EC are patient representatives as well as coapplicants on the grant. They contributed to this manuscript, providing expertise and input from the patient perspective and gave approval of the final version. SA, AH, MA, RB, GR, KS and MZ also contributed to the development of the detailed operational trial protocol. They provided expertise in physiotherapy, statistics, health economics and trial management and contributed to writing this manuscript and gave approval of the final version. SA and AH led on producing the first draft of the manuscript, submitted the first draft and acted as corresponding author during the review process. TS will be corresponding author for post-publication communication. This protocol was written following the SPIRIT protocol guidance.

Funding REPPORT is funded by the NIHR Health Technology Assessment programme (HTA project: NIHR134398). The trial is sponsored by the University of Warwick. This study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Competing interests AM, MU, DRE, TS and HP are coinvestigators on two current (RACER-Knee and RACER-Hip) and one completed (START:REACTS) NIHR funded studies (AM chief investigator of two) that have, or have had, additional support from Stryker Ltd. There is no link to the current trial. AM, MU, HP, NEF and MF are coinvestigators on grants funded by the Australian NHMRC. MU is chief investigator or coinvestigator on multiple previous and current research grants from the UK National Institute for Health Research and is a coinvestigator on grants funded by the Norwegian MRC. He was an NIHR Senior Investigator until March 2021. He is a director and shareholder of Clinvivo Ltd that provides electronic data collection for health services research. He is part of an academic partnership with Serco Ltd, funded by the European Social Fund, related to return-to-work initiatives. NEF is chief investigator or coinvestigator on multiple previous and current research grants from the UK NIHR, and Australian NHMRC and MRFF. She was an NIHR Senior Investigator and is currently an Australian National Health and Medical Research Council (NHMRC) Investigator Fellow (ID: 2018182). MRW undertakes teaching on basic sciences for Orthopaedic trainees preparing for the FRCS. His institution receives market rate payment for this teaching from Heraeus. MRW was a coapplicant on a grant funded by Stryker Ltd to investigate the outcomes of the Triathlon total knee replacement which is unrelated to this study. MRW is PI of the National Joint Registry lot 2 contract (statistical analysis) team and PI or coapplicant on multiple previous NIHR funded studies.

Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.

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