An evidence synthesis of the international knowledge base for new care models to inform and mobilise knowledge for multispecialty community providers (MCPs)

Abstract

BackgroundNHS England’s Five Year Forward View (NHS England, Five Year Forward View, 2014) formally introduced a strategy for new models of care driven by simultaneous pressures to contain costs, improve care and deliver services closer to home through integrated models. This synthesis focuses on a multispecialty community provider (MCP) model. This new model of care seeks to overcome the limitations in current models of care, often based around single condition-focused pathways, in contrast to patient-focused delivery (Royal College of General Practitioners, The 2022 GP: compendium of evidence, 2012) which offers greater continuity of care in recognition of complex needs and multimorbidity.MethodsThe synthesis, an innovative combination of best fit framework synthesis and realist synthesis, will develop a “blueprint” which articulates how and why MCP models work, to inform design of future iterations of the MCP model. A systematic search will be conducted to identify research and practice-derived evidence to achieve a balance that captures the historical legacy of MCP models but focuses on contemporary evidence. Sources will include bibliographic databases including MEDLINE, PreMEDLINE, CINAHL, Embase, HMIC and Cochrane Library; and grey literature sources. The Best Fit synthesis methodology will be combined with a synthesis following realist principles which are particularly suited to exploring what works, when, for whom and in what circumstances.DiscussionThe aim of this synthesis is to provide decision makers in health and social care with a practical evidence base relating to the multispecialty community provider (MCP) model of care.Systematic review registrationPROSPERO CRD42016039552.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0346-x) contains supplementary material, which is available to authorized users.

The impact of new forms of large-scale general practice provider collaborations on England’s NHS: a systematic review

“…Further work has since been undertaken, 9,29,30 and more research is underway, which may help fill some of the gaps identified. [31][32][33] This review is complemented by a review of the wider academic and grey literature examining the development and impact of national and international initiatives with similarities to large-scale general practice organisations in England, such as specialist clinical networks, GP-led commissioning, out-of-hours cooperatives, and integrated care initiatives. 23 Comparison with existing literature Despite the recent focus by national policymakers in England on increasing organisational size to improve quality of care and generate efficiencies in general practice, there is no consistent association between scale, quality of care, or the generation of efficiency savings in the healthcare literature.…”

The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis

“…from NHSE). 61 For all types of evidence, we focused on their theoretical or contextual contribution, recognising that formal quality assessment of such heterogeneous items would be of little value. For conceptual and contextual types of evidence, we employed a reflexive approach to locate the contribution of each item within the overall body of evidence and to assess its specific contribution.…”

“…57 The first eight candidates for ACSs were announced in June 2017, 59 with the remit to retain existing health INTRODUCTION NIHR Journals Library www.journalslibrary.nihr.ac.uk Chapter 2 Review methodology: stakeholder engagement, programme theory elicitation and analysis of the literature O n initiation, the review team registered a review protocol with the PROSPERO database and published an expanded version within a peer-reviewed journal. 61 This chapter first describes how we analysed existing logic models to identify programme theories and then engaged with stakeholders in order to verify and elucidate these potential programme theories. Subsequently, we conducted a systematic search of the relevant literature, supplemented by further purposive explorations for evidence, underpinning each programme theory component.…”

“…Our original review questions were as follows: 61 l What are the foremost theories of change inherent within the MCP model of care? l What seem to be the 'active ingredients' that should inform the design of MCP models of care?…”

“…No major changes to the review process were made subsequent to the publication of the review protocol. 61 However, to maximise the utility of the realist synthesis for project stakeholders, and to enhance its value for NIHR, we decided to complement our approach to full realist reviews of key programme theory components with a broadly analogous process of 'mapping' for other components identified during the identification of a programme theory.…”