GP Workforce Sustainability to maximise effective and equitable patient care: a realist review of what works, for whom and in what circumstances?

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

4C.1

Presenter:

Sophie Park

Twitter:

@SophieParkUCL

Co-authors:

Emily Owen, Bryan Burford, Tanya Cohen, Claire Duddy, Harry Dunn, Claire Goodman, Cecily Henry, Lily Lamb, Margaret Ogden, Tim Rapley, Eliot Rees, Gillian Vance, Geoff Wong.

Author institutions:

University College London, University of Oxford, Newcastle University, Northumbria University, and the University of Hertfordshire.

Problem

There are not enough General Practitioners (GPs) in the UK National Health Service. This problem is worse in areas of the country where poverty and underinvestment in health and social care mean patients experience poorer health compared with wealthier regions. Encouraging more doctors to choose and continue in a GP career is a government priority. Our review will examine which aspects of the healthcare system affect GP workforce sustainability, how, why, and for whom. By taking a system and theory-driven approach to understanding what works, in which contextual circumstances, and to what extent, we aim to explore and make visible the often unsaid or implicit issues that influence working environments, relationships, and organisational culture. The findings from our review will offer structural and organisational recommendations to inform sustainable, context-specific ways of future working, which can underpin effective and equitable patient care.

Approach

We are conducting a realist review, synthesising data from the published literature to produce a refined evidence-based programme theory that will identify the important contexts and mechanisms which underpin observed outcomes relating to GP workforce sustainability to support the delivery of effective and equitable patient care. A realist review is an interpretive and theory-driven approach to evidence synthesis, that brings together data drawn from quantitative, qualitative, mixed methods research, the wider grey literature, stakeholder, and PPI engagement. Using this data and a realist logic of analysis allows us to examine a diverse range of evidence with a clear focus on understanding factors which support or challenge GP workforce sustainability, how these are shaped by important contexts, and the mechanisms that underpin them. Based on this understanding, captured in our final programme theory, we will be able to identify and prioritise important system-level contexts that may be amenable to change.

Findings

We will present our emerging findings in the form of a programme theory that will explain the relationships between the interconnected components (e.g. the nature of social interactions between patients, colleagues, and external institutions; alignment of personal and policy priorities; organisational support structures; and leadership culture) that work together in an integrated and coordinated way to sustain and enhance the GP workforce.

Consequences

Our research will generate new knowledge about the interdependencies between contextual factors, causal mechanisms, and outcomes of interest. The findings and refined programme theory can inform strategies and interventions intended to support, facilitate, and assist the GP workforce in delivering equitable and effective patient care. We will identify critical gaps in knowledge and prioritise the expectations for scope and nature of future GP work.

Submitted by:

Emily Owen

Funding acknowledgement:

This project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.