• glue ear surgery
• guidelines

Black and Hutchings present an intriguing account of the rise and fall of glue ear surgery in two English regions.¹ They speculate that the acceleration of the decline from 1992 may have been due to the Effective Health Care bulletin on glue ear, helped by five “contextual features”. One of these was the concurrent structural change to the NHS arising from the introduction of healthcare commissioning.

We write to suggest another possible contextual feature—namely, a project entitled “Getting Research into Practice (GRiP)”. GRiP was a project started in 1992, initially within the Oxford region, that aimed to help the new purchasing health authorities find and apply evidence of effectiveness in their work.^2,3 One of the four topics chosen for GRiP was surgery for children with suspected glue ear.

This was first taken forward in Berkshire and later in the other three counties of the region. From 1995 GRiP (and successor programmes) was generalised to the whole of the Anglia and Oxford regions. GRiP took a multifaceted approach to implementing change. There is evidence that multifaceted interventions targeting different barriers to change are more likely to be effective than single interventions.⁴ In addition, surgery for glue ear became a topic for performance management in the Anglia and Oxford region before other regions.

There would be several ways of exploring the specific contribution of GRiP to the decline of glue ear surgery. One would be to see if the decline was faster in Berkshire, or in the rest of the Oxford region, or in the Anglia and Oxford regions, than elsewhere. Another would be to compare the rate of decline of topics of low appropriateness covered in Effective Health Care bulletins but not in the GRiP project with those that were.

We are not aware of any quantitative evaluation of GRiP, although there has been a qualitative analysis of the process.⁵