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Delegating home visits in general practice: a realist review on the impact on GP workload and patient care

Abrams, R; Wong, G; Mahtani, K; Tierney, S; Boylan, A-M; Roberts, N; Park, S; (2020) Delegating home visits in general practice: a realist review on the impact on GP workload and patient care. British Journal of General Practice , 70 (695) e412-e420. 10.3399/bjgp20X710153. Green open access

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Abstract

Background: UK general practice is being shaped by new ways of working. Traditional GP tasks are being delegated to other staff with the intention of reducing GPs’ workload and hospital admissions, and improving patients’ access to care. One such task is patient-requested home visits. However, it is unclear what impact delegated home visits may have, who might benefit, and under what circumstances. Aim: To explore how the process of delegating home visits works, for whom, and in what contexts. Design and setting: A review of secondary data on home visit delegation processes in UK primary care settings. Method: A realist approach was taken to reviewing data, which aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes. A range of data has been used including news items, grey literature, and academic articles. Results: Data were synthesised from 70 documents. GPs may believe that delegating home visits is a risky option unless they have trust and experience with the wider multidisciplinary team. Internal systems such as technological infrastructure might help or hinder the delegation process. Healthcare professionals carrying out delegated home visits might benefit from being integrated into general practice but may feel that their clinical autonomy is limited by the delegation process. Patients report short-term satisfaction when visited by a healthcare professional other than a GP. The impact this has on long-term health outcomes and cost is less clear. Conclusion: The delegation of home visits may require a shift in patient expectation about who undertakes care. Professional expectations may also require a shift, having implications for the balance of staffing between primary and secondary care, and the training of healthcare professionals.

Type: Article
Title: Delegating home visits in general practice: a realist review on the impact on GP workload and patient care
Open access status: An open access version is available from UCL Discovery
DOI: 10.3399/bjgp20X710153
Publisher version: https://doi.org/10.3399/bjgp20X710153
Language: English
Additional information: ©The Authors http://creativecommons.org/licenses/by/4.0/ This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/).
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10090951
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