What mechanisms support Advance Clinical Practitioners to support Primary Care serving deprived communities

Problem

The NHS plan commits £891 million to invest into primary care teams over the next 5 years in the form of clinical practitioners from non-medical backgrounds (1). Workforce challenges in previous systems of funding have led to an ‘inverse care law’ operating with respect to access to high quality primary care for our most deprived communities (2,3). Used wisely, this investment has potential to mitigate these problems. Many are concerned regarding the available evidence regarding the best way of effectively integrating non-medical practitioners to provide generalist care to these communities (4).

1. NHS England, British Medical Association. Investment and evolution : A five-year framework for GP contract reform to implement The NHS Long Term Plan [Internet]. NHS England; 2019. Available from: www.longtermplan.nhs.uk

2. Tudor Hart J. The Inverse Care Law. Lancet. 1971;(7696):405–12.

3. Mercer SW, Watt GCM. The inverse care law: Clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med. 2007;5(6):503–10.

4. Marshall M, Gray DP. General practice is making a leap in the dark. BMJ [Internet]. 2016 Oct 28 [cited 2017 Jan 12];355:i5698. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.i5698

Approach

A realist evaluation of the integration of advanced clinical practitioners (ACPs) in supporting primary care to deprived populations is being undertaken. The first stage of the realist evaluation has been completed through a review of the literature and stakeholder consultation (GPs, ACPs, Commissioners) from the South Yorkshire region

Findings

The work so far has identified the context-mechanism-outcome (CMO) configurations that are likely to be operating as ACPs integrate themselves into primary care teams. These CMO will be presented along with the potential triggers for the mechanisms identified to activate in different contexts and outline plans for empirical data collection to test the validity of the proposed CMO configurations.

Consequences

A better understanding of how the successful integration of non-medical practitioners into primary care teams to provide high quality generalist are to deprived communities is required. An increased understanding will be critical if the proposed investment in non-medical practitioners is going to be utilised to address the current inverse care law in access to quality primary care.