Understanding the impact of delegated home visiting services accessed via general practice by community dwelling patients: a realist review protocol

Lay Summary

There have been a number of recent policies concerning the organisation of primary health care, including GP Forward View 2016. Since the publication of these, service innovation within primary care has led to a shift in the way in which healthcare is designed. New models of care are intended to address the workforce ‘crisis’ and address patient access to care by providing a programme of improvements. One suggested improvement has been ‘early visiting services’- the delegation of traditional GP led home visits, to other qualified professionals such as advanced nurse practitioners, paramedics, emergency care practitioners or locum GPs. However, it remains unclear how, when, why and for whom these innovations are helpful. The aim of this review is to bring together a variety of evidence about delegated home visits. We include policy documents; research texts (both UK and international); and debate articles. Where they exist, we have also included evaluations of delegated home visit services. The purpose of our review is to understand the conditions (or 'contexts') and processes (or 'mechanisms') which facilitate particular outcomes, in order to examine when (and when not) delegated home visits might be useful to support primary health care delivery for patients. Specifically we ask the question: Within the existing and available literature, what are the causal explanations for the ways in which primary care early visiting services (EVS) contribute to patient care and clinical workload?

Ruth Abrams, Geoff Wong, Nia Roberts, Kamal Mahtani, Stephanie Tierney, Anne-Marie Boylan, Sophie Park