Implementing relational continuity in general practice - understanding who needs it, when, to what extent, how and why: a realist review

Research question Implementing relational continuity in general practice - who needs it, when, to what extent, how and why? Background Relational continuity of care (RCC) refers to the ongoing and therapeutic relationship between a patient and a clinician that results in accumulated knowledge of the patient. It fosters improved communication and trust, and helps clinicians to sustain a sense of responsibility. Research shows that RCC in general practice is associated with improved patient outcomes, such as reduced acute hospital admissions and decreased mortality, lower healthcare costs, and better patient experience. Despite such benefits, recent NHS reorganisations and the GP workforce crisis have led to an increasing reliance on multidisciplinary and part-time working and a fragmented healthcare system with multiple access points. RCC has been consistently decreasing over the last decade and in 2023 only 16% of patients were able to see their preferred GP most of the time. There have been calls for the prioritisation and incentivisation of RCC but it would be difficult to deliver this for all patients within the current context of general practice. Aims and objectives We aim to understand: 1. The underlying mechanisms through which RCC and its benefits are achieved 2. The populations of patients and clinicians for which RCC should be prioritised 3. The contextual conditions that constrain or facilitate RCC 4. The care models and interventions that are likely to lead to optimal implementation of RCC. To address our research’s aims we will: ? Conduct a realist review to develop an evidenced-based programme theory of its optimal implementation ? Develop relevant recommendations for best practice. Methods and timelines Realist reviews are particularly suited for the study of phenomena, such as RCC, which are inherently complex and multifaceted. We will follow Pawson’s five iterative stages over 18 months: 1) locating existing theories; 2) searching for evidence; 3) article selection; 4) extracting and organising data; 5) synthesising the evidence and drawing conclusions. A realist programme theory will be developed that explains how, why, for whom and to what extent interventions that facilitate RCC within general practice work. We will work with a stakeholder group, including policy makers, healthcare professionals, our public co-applicants and members of the public and patients, throughout the project. We will follow RAMESES quality standards for conducting a realist review, developed by one of the research team. Outputs and dissemination Our findings will be used to develop evidence-based, user-friendly, practical recommendations on the prioritisation and optimal implementation of RCC. We will work with our stakeholder group and PPI members and an infographics expert to jointly develop outputs to reach different audiences including: GP practices, policy makers, commissioners, academics, patients and the public. The study findings will be shared via conference abstracts and presentations, at least one peer-review publication in a high impact journal, a plain English summary, two end-of-study events, a series of social media infographics and a short video. This research has the potential to influence healthcare policy and practice at a critical time for the NHS. Optimising the delivery of RCC can have significant positive impacts for patient outcomes and experience and for the sustainability of primary care and the wider NHS.