A Realist Review of General Practice Delegated Home Visits: Task Shifting, Sharing, Mixing and Delegating

Context: UK General Practice is being shaped by new ways of working with the release of both the NHS long-term plan and GP contract (BMA, 2019; NHS, 2019). Multidisciplinary teams and workforce expansion see the shifting, sharing, mixing and delegation of traditional GP tasks to other staff such as community paramedics. One of these tasks is the delegation of patient home visits in order to reduce both GP workload and hospital admissions. Yet the mechanisms of delegation (how and why delegation occurs) remain opaque and are likely to be highly dependent on a range of contexts. Objective: Our evidence synthesis explores the ways in which delegation of home visits relies upon context, which subsequently affects both patient outcomes and clinical workload within primary care settings. Study Design: Evidence is consolidated through a systematic realist review. Dataset: We have synthesised a range of relevant data including qualitative, quantitative, mixed-methods research and grey literature. Population: A total of 70 studies relating to primary care, with similar healthcare systems to the UK discussing delegation are included. Outcome Measures: A realist review produces context-mechanism-outcome configurations, which provide causal explanations. Results: Preliminary findings will be presented. Contexts such as the nature of employment, patient conditions and GP perspectives to delegation will be articulated. The impact on patient satisfaction and clinical workload will be discussed in relation to outcomes. Mechanisms such as risk tolerance and trust will be elucidated and the tensions between multi-disciplinary professional identities highlighted. Expected Outcomes: Our findings and causal explanations will produce review findings with potential to help future implementation of delegated home visits and provide guidance to support GP decision-making about how and when to delegate patient home visits.