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Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation

Alison Cooper Orcid Logo, Michelle Edwards Orcid Logo, Freya Davies, Delyth Price, Pippa Anderson, Andrew Carson-Stevens, Matthew Cooke, Jeremy Dale, Liam Donaldson, Bridie Evans Orcid Logo, Barbara Harrington, Julie Hepburn, Peter Hibbert, Thomas C Hughes Orcid Logo, Alison Porter Orcid Logo, Aloysius Niroshan Siriwardena Orcid Logo, Alan Watkins Orcid Logo, Helen Snooks Orcid Logo, Adrian Edwards

Emergency Medicine Journal, Volume: 41, Issue: 5, Pages: 287 - 295

Swansea University Authors: Bridie Evans Orcid Logo, Alison Porter Orcid Logo, Alan Watkins Orcid Logo, Helen Snooks Orcid Logo

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DOI (Published version): 10.1136/emermed-2023-213426

Abstract

Background Addressing increasing patient demand and improving ED patient flow is a key ambition for NHS England. Delivering general practitioner (GP) services in or alongside EDs (GP-ED) was advocated in 2017 for this reason, supported by £100 million (US$130 million) of capital funding. Current evi...

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Published in: Emergency Medicine Journal
ISSN: 1472-0205 1472-0213
Published: BMJ 2024
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Delivering general practitioner (GP) services in or alongside EDs (GP-ED) was advocated in 2017 for this reason, supported by £100 million (US$130 million) of capital funding. Current evidence shows no overall improvement in addressing demand and reducing waiting times, but considerable variation in how different service models operate, subject to local context.Methods We conducted mixed-methods analysis using inductive and deductive approaches for qualitative (observations, interviews) and quantitative data (time series analyses of attendances, reattendances, hospital admissions, length of stay) based on previous research using a purposive sample of 13 GP-ED service models (3 inside-integrated, 4 inside-parallel service, 3 outside-onsite and 3 with no GPs) in England and Wales. We used realist methodology to understand the relationship between contexts, mechanisms and outcomes to develop programme theories about how and why different GP-ED service models work.Results GP-ED service models are complex, with variation in scope and scale of the service, influenced by individual, departmental and external factors. Quantitative data were of variable quality: overall, no reduction in attendances and waiting times, a mixed picture for hospital admissions and length of hospital stay. Our programme theories describe how the GP-ED service models operate: inside the ED, integrated with patient flow and general ED demand, with a wider GP role than usual primary care; outside the ED, addressing primary care demand with an experienced streaming nurse facilitating the ‘right patients’ are streamed to the GP; or within the ED as a parallel service with most variability in the level of integration and GP role.Conclusion GP-ED services are complex . Our programme theories inform recommendations on how services could be modified in particular contexts to address local demand, or whether alternative healthcare services should be considered.</abstract><type>Journal Article</type><journal>Emergency Medicine Journal</journal><volume>41</volume><journalNumber>5</journalNumber><paginationStart>287</paginationStart><paginationEnd>295</paginationEnd><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1472-0205</issnPrint><issnElectronic>1472-0213</issnElectronic><keywords/><publishedDay>1</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-05-01</publishedDate><doi>10.1136/emermed-2023-213426</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This study was funded by the National Institute for Health Research (NIHR) HS&amp;DR Project 15/145/04 and will be published in full in the NIHR Journals Library. 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spelling v2 66503 2024-05-23 Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation 6098eddc58e31ac2f3e070cb839faa6a 0000-0003-0293-0888 Bridie Evans Bridie Evans true false fcc861ec479a79f7fb9befb13192238b 0000-0002-3408-7007 Alison Porter Alison Porter true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false 2024-05-23 MEDS Background Addressing increasing patient demand and improving ED patient flow is a key ambition for NHS England. Delivering general practitioner (GP) services in or alongside EDs (GP-ED) was advocated in 2017 for this reason, supported by £100 million (US$130 million) of capital funding. Current evidence shows no overall improvement in addressing demand and reducing waiting times, but considerable variation in how different service models operate, subject to local context.Methods We conducted mixed-methods analysis using inductive and deductive approaches for qualitative (observations, interviews) and quantitative data (time series analyses of attendances, reattendances, hospital admissions, length of stay) based on previous research using a purposive sample of 13 GP-ED service models (3 inside-integrated, 4 inside-parallel service, 3 outside-onsite and 3 with no GPs) in England and Wales. We used realist methodology to understand the relationship between contexts, mechanisms and outcomes to develop programme theories about how and why different GP-ED service models work.Results GP-ED service models are complex, with variation in scope and scale of the service, influenced by individual, departmental and external factors. Quantitative data were of variable quality: overall, no reduction in attendances and waiting times, a mixed picture for hospital admissions and length of hospital stay. Our programme theories describe how the GP-ED service models operate: inside the ED, integrated with patient flow and general ED demand, with a wider GP role than usual primary care; outside the ED, addressing primary care demand with an experienced streaming nurse facilitating the ‘right patients’ are streamed to the GP; or within the ED as a parallel service with most variability in the level of integration and GP role.Conclusion GP-ED services are complex . Our programme theories inform recommendations on how services could be modified in particular contexts to address local demand, or whether alternative healthcare services should be considered. Journal Article Emergency Medicine Journal 41 5 287 295 BMJ 1472-0205 1472-0213 1 5 2024 2024-05-01 10.1136/emermed-2023-213426 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This study was funded by the National Institute for Health Research (NIHR) HS&DR Project 15/145/04 and will be published in full in the NIHR Journals Library. Further information available at: https://www.journalslibrary.nihr.ac.uk/ programmes/hsdr/1514504/#/. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. 2024-06-17T15:56:45.7987722 2024-05-23T15:14:23.3030997 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Alison Cooper 0000-0001-8660-6721 1 Michelle Edwards 0000-0001-7432-2828 2 Freya Davies 3 Delyth Price 4 Pippa Anderson 5 Andrew Carson-Stevens 6 Matthew Cooke 7 Jeremy Dale 8 Liam Donaldson 9 Bridie Evans 0000-0003-0293-0888 10 Barbara Harrington 11 Julie Hepburn 12 Peter Hibbert 13 Thomas C Hughes 0000-0001-5490-1267 14 Alison Porter 0000-0002-3408-7007 15 Aloysius Niroshan Siriwardena 0000-0003-2484-8201 16 Alan Watkins 0000-0003-3804-1943 17 Helen Snooks 0000-0003-0173-8843 18 Adrian Edwards 19 66503__30573__d03cb085f0514444b40ca920b069f98c.pdf 66503.pdf 2024-06-07T15:03:22.9124075 Output 3387921 application/pdf Version of Record true This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license. true eng https://creativecommons.org/licenses/by/4.0/
title Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation
spellingShingle Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation
Bridie Evans
Alison Porter
Alan Watkins
Helen Snooks
title_short Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation
title_full Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation
title_fullStr Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation
title_full_unstemmed Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation
title_sort Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation
author_id_str_mv 6098eddc58e31ac2f3e070cb839faa6a
fcc861ec479a79f7fb9befb13192238b
81fc05c9333d9df41b041157437bcc2f
ab23c5e0111b88427a155a1f495861d9
author_id_fullname_str_mv 6098eddc58e31ac2f3e070cb839faa6a_***_Bridie Evans
fcc861ec479a79f7fb9befb13192238b_***_Alison Porter
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
ab23c5e0111b88427a155a1f495861d9_***_Helen Snooks
author Bridie Evans
Alison Porter
Alan Watkins
Helen Snooks
author2 Alison Cooper
Michelle Edwards
Freya Davies
Delyth Price
Pippa Anderson
Andrew Carson-Stevens
Matthew Cooke
Jeremy Dale
Liam Donaldson
Bridie Evans
Barbara Harrington
Julie Hepburn
Peter Hibbert
Thomas C Hughes
Alison Porter
Aloysius Niroshan Siriwardena
Alan Watkins
Helen Snooks
Adrian Edwards
format Journal article
container_title Emergency Medicine Journal
container_volume 41
container_issue 5
container_start_page 287
publishDate 2024
institution Swansea University
issn 1472-0205
1472-0213
doi_str_mv 10.1136/emermed-2023-213426
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background Addressing increasing patient demand and improving ED patient flow is a key ambition for NHS England. Delivering general practitioner (GP) services in or alongside EDs (GP-ED) was advocated in 2017 for this reason, supported by £100 million (US$130 million) of capital funding. Current evidence shows no overall improvement in addressing demand and reducing waiting times, but considerable variation in how different service models operate, subject to local context.Methods We conducted mixed-methods analysis using inductive and deductive approaches for qualitative (observations, interviews) and quantitative data (time series analyses of attendances, reattendances, hospital admissions, length of stay) based on previous research using a purposive sample of 13 GP-ED service models (3 inside-integrated, 4 inside-parallel service, 3 outside-onsite and 3 with no GPs) in England and Wales. We used realist methodology to understand the relationship between contexts, mechanisms and outcomes to develop programme theories about how and why different GP-ED service models work.Results GP-ED service models are complex, with variation in scope and scale of the service, influenced by individual, departmental and external factors. Quantitative data were of variable quality: overall, no reduction in attendances and waiting times, a mixed picture for hospital admissions and length of hospital stay. Our programme theories describe how the GP-ED service models operate: inside the ED, integrated with patient flow and general ED demand, with a wider GP role than usual primary care; outside the ED, addressing primary care demand with an experienced streaming nurse facilitating the ‘right patients’ are streamed to the GP; or within the ED as a parallel service with most variability in the level of integration and GP role.Conclusion GP-ED services are complex . Our programme theories inform recommendations on how services could be modified in particular contexts to address local demand, or whether alternative healthcare services should be considered.
published_date 2024-05-01T15:56:44Z
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