PT  - JOURNAL ARTICLE
AU  - Ruth Abrams
AU  - Geoff Wong
AU  - Kamal R Mahtani
AU  - Stephanie Tierney
AU  - Anne-Marie Boylan
AU  - Nia Roberts
AU  - Sophie Park
TI  - Delegating home visits in general practice: a realist review on the impact on GP workload and patient care
AID  - 10.3399/bjgp20X710153
DP  - 2020 Jun 01
TA  - British Journal of General Practice
PG  - e412--e420
VI  - 70
IP  - 695
4099  - http://bjgp.org/content/70/695/e412.short
4100  - http://bjgp.org/content/70/695/e412.full
SO  - Br J Gen Pract2020 Jun 01; 70
AB  - 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.