Institute of Epidemiology & Health Care


Departmental Seminar - A Realist Review of Delegated Home Visits in General Practice

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

Speaker: Ruth Abrams

Abstract: 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). Traditional GP tasks are being delegated to other staff with the intention of reducing GP workload, hospital admissions and improving patient access to care. One such task is patient generated home visits. Yet the mechanisms of delegation remain opaque and are likely to be dependent on a range of contexts. Our evidence synthesis explores how the process of delegating home visits work, for whom and in what contexts.

We have synthesised relevant data including qualitative, quantitative, mixed-methods research and grey literature, following the systematic realist review stages advocated by Pawson et al (2005). Stakeholders such as Clinical commissioners, CCG members, GPs and paramedics were consulted during the early stage of this review to help the research team understand the ways in which home visit delegation is conceptualised and operationalised in practice. A total of 70 studies relating to primary care, with similar healthcare systems to the UK and discussing delegation are included. Three overarching themes have been constructed, comprising of a series of context-mechanism-outcome configurations. 

Findings suggest that the nature of employment, patient conditions and GP perspectives form complex contexts for work delegation to occur in. Whilst outcomes such as patient satisfaction appear to be high, the ability of delegation to reduce clinical workload is unclear. Mechanisms such as risk tolerance and trust among multidisciplinary teams are likely to affect delegation processes and tensions exist between the sustainability of this intervention. Our review findings may help with the future implementation of delegated home visits and provide guidance to support GP decision-making about how and when to delegate patient home visits.

The research team are disseminating these research findings on 23rd Oct as part of an interactive performance. Free tickets are available to book here:  https://www.ucl.ac.uk/culture/whats-on/there-doctor-house