Community Pharmacy and General Practice collaborative and integrated working: a realist review

Problem

The NHS Long-Term Plan is underpinned by expectations of collaborative and integrated working in primary care. The opportunities and challenges this presents for organisation and delivery in practice are relatively unexplored. NHS Long-Term Plan implementation has been rapid and involves a range of approaches across diverse contexts and settings. This realist review focuses on the working relationships between Community Pharmacy (CP) and General Practice (GP). Importantly, the review will explore and make visible the wider human, policy, regulatory, and professional elements that may influence this working relationship. The aim of our review is to understand how, when, and why working arrangements may provide the conditions necessary for optimal communication, decision-making, and collaborative and integrated working between CP and GP. This will inform ways of future working and maximise opportunities for effective and equitable patient care.

Approach

To make sense of the complexities inherent in the working relationships between CP and GP, we have chosen a realist review approach. This is an interpretative and theory-driven approach to synthesising evidence from grey literature, qualitative, quantitative, and mixed-methods research. It enables the use of a range of data types to make sense of and address the context sensitive outcomes arising from interactions between CP and GP. It develops an understanding (expressed in the form of a realist programme theory) that will be transferable across different structures and contexts within which CP and GP operate.

Findings

We will present our emerging findings in the form of a programme theory that explains the relationships between provider contractual requirements, NHS England policy drivers, professional identities, organisational cultures within GP and CP, and how financial incentives and competition may shape strategies, behaviours, and policy implementation.

Consequences

This review will provide insights and solutions to maximise CP and GP collaboration and integration. The findings and refined programme theories will ensure patients health is kept central to CP and GP working relationships and processes. These working relationships and arrangements impact on patient experience, patient safety and medication errors, access, care, and formal referral; alongside professional capacity, training, and workload. The review findings are likely to have broader relevance to other primary care interfaces and the future productive shaping of integrated and collaborative working.