Primary care micro-teams: A systematic review to describe and examine the opportunities, challenges and implications of implementation for patients and health care professionals.

Problem

There has been a recent trend towards creating larger primary care practices with the assumption that interdisciplinary teams can deliver improved and more cost-effective services to patients with better accessibility. Micro-teams have been proposed as a way to mitigate some of the potential challenges with practice expansion, including continuity of care. We aimed to review the available literature to examine: how micro-teams are described; and the opportunities and challenges which implementation of primary care micro-teams can produce for practice staff and patients.

Approach

We have worked closely with PPI collaborators from the inception of this review, alongside stakeholder discussions with practice staff involved in micro-team implementation or delivery. CINAHL, Cochrane Library, Embase, MEDLINE and Scopus were searched for studies in English. Grey literature was also sourced from Google Scholar, Government Websites, CCG websites, General Practice directives and strategies with the advice of stakeholders. Studies were included if they gave evidence regarding the implementation of micro-teams. Data from studies were synthesised using Framework analysis, using both deductive and inductive approaches. We used iterative stakeholder participation to embed the perspectives of those whom micro-teams could impact. Included studies were quality assessed using the Critical Appraisal Skills Programme tools for varying study designs. The quality assessment was not used to exclude any evidence but rather to develop a narrative discussion evaluating included literature.

Findings

The presentation will discuss emergent findings about how primary care micro teams development and implementation have been described and potential implications for future practice. Results include: the characteristics of included literature; a description of the range of ways in which micro-teams have been characterised and implemented; and reported outcomes and experiences of patients and staff.

Consequences

How primary care is organised has the potential to impact upon the nature and quality of patient care. This review contributes to the current debates surrounding the organisation of care and how this can impact the experiences and outcomes of patients. It brings together a range of literature and examines how, in what manner and why micro-teams have been considered and used in the primary care setting. The analysis identifies key opportunities and challenges from the literature which will help inform recommendations for future practice.