General Practitioners’ Role in Advancing Practice in Care Homes: A Realist Review

Background Despite recent focus on improving healthcare in care homes, it is unclear what role General Practitioners (GPs) should play. To provide evidence for future practice we set out to explore how GPs have been involved in such improvements. Methods Realist review comprised interviews with GP leaders, theory driven literature searches and stakeholder interviews supplemented by searches on GP led medication reviews and end-of-life care. Medline, Embase, CINAHL, Psycinfo, Web of Science and the Cochrane library were searched. Grey literature was identified through internet searches and professional networks. Studies were included based upon relevance. Data were coded to develop and test contexts, mechanisms and outcomes for improvements involving GPs. Results Evidence was synthesised from 30 articles. Programme theories described: (1) “negotiated working with GPs”, where other professionals led improvement and GPs provided expertise; and (2) “GP involvement in national/regional improvement programmes”. The expertise of GPs was vital to many improvement programmes, with their medical expertise or role as co-ordinators of primary care proving pivotal. GPs had limited training in quality improvement and care home improvement work had to be negotiated in the context of wider primary care commitments. Conclusions GPs are central to quality improvement in healthcare in care homes. Their contributions relate to their specialist expertise and recognition as leaders of primary care but are challenged by available time and resources to develop this role.