Experiences of OOH task-shifting from GPs: Systematic review of qualitative studies.

Problem

It is increasingly recognised that the GP workforce is insufficient to meet the rising demands of patient care in the out-of-hours (OOH) primary care setting. In response, current Government policy promotes a greater skill-mix of non-medical practitioners (NMPs) to fill roles traditionally occupied by GPs, referred to as task-shifting. To date, there is limited evidence collating experiences of task-shifting to inform optimal OOH care delivery. In this study, we aimed to synthesise qualitative evidence on NMP and GP experiences of task-shifting in the OOH primary care setting.

Approach

A scoping review with electronic searches across CINAHL, PsychInfo, Cochrane, Medline and Embase, and OpenGrey from database inception to October 2020 for articles including urgent or OOH primary care services, utilising task-shifting or role delegation from GPs to NMPs. Included studies used qualitative methods or mixed designs with qualitative elements. After abstract and full-text screening, articles were selected and their quality appraised. Thematic synthesis was used to collate results following the methods outlined by Thomas & Harden.

Findings

Out of 2490 studies screened, four met the inclusion criteria. These were mixed-methods studies conducted in the UK between 2011 and 2019. Two reported on advanced nurse practitioner experiences of task-shifting through OOH home visits; one study reported on physician assistant experiences of integrating within OOH services, and the final article describes an evaluation on suitability of paramedic training to work in OOH services. Key findings highlight the importance of: 1) organisational level recognition of NMP backgrounds engendering trust and respect, 2) NMP confidence and satisfaction is facilitated by appropriate training, support, and mentoring, and 3) a culture of collaboration between GPs and NMPs can promote clinical autonomy.

Consequences

NMPs have the potential to make a substantial contribution to the OOH setting, which is essential to meet growing patient demand. More evidence is needed on experiences of task-shifting in OOH primary care. NMP and GP experiences highlight the need for further training specific to OOH services. Mentorship and support to manage more varied and complex clinical cases could permit more effective OOH services and better patient care.