Patient Allocation in Multi-Specialist GP Practices: A Scoping Review

Problem

Pressure on General Practice is increasing in England because the population both growing and getting older and sicker (ONS, 2022), and the number of practicing GPs is falling (BMA, 2024). Therefore, many GP Practices are starting to direct patients to other health professionals where appropriate, including physiotherapists, pharmacists and paramedics, in addition to GPs, driven by the introduction of the Additional Roles Reimbursement Scheme (ARRS) by NHS England in 2019. The expectation is that these new healthcare professionals will improve patient access and that at least some of these roles will be First Contact Practitioners (FCPs), who see patients directly, without them needing to see the GP first. However, recent research shows that most appointments to FCP physiotherapists came after referral from a GP (Lamb et al, 2023), thereby retaining the GP as the bottleneck in the process. This suggests that there is a fundamental gap in understanding how to operationalise FCP roles effectively within GP practices and there is currently little research to understand the mechanisms and impact of this change. This paper therefore aims to undertake a scoping review to assess the extent of the literature on patient allocation processes in general practice, with a focus on how patients are allocated to GPs and other multi-specialist healthcare professionals.

Approach

The scoping review follows PRISMA guidelines and is broad in scope, considering all relevant studies published in selected academic databases, along with grey literature from grant databases and health organisations in the UK. The search strategy was developed through discussions between the researchers and pilot searches to identify appropriate keywords and search combinations. Once these were confirmed, full searches were undertaken across both academic and grey literature databases. Titles were excluded if they were older than 20yrs, not written in English or were not directly related to patient allocation or care navigation in primary care. Data from included papers was extracted and checked by the review team and key themes were identified.

Findings

Initial results show that academic literature typically reports issues around access (getting appointments), the triage process to establish appointment urgency and often also the mode of appointment (ie. online, in-person, by phone), or referrals onward (after the appointment). The grey literature, in addition, discusses the additional roles, along with the skills and capabilities they bring and the practical aspects of utilising this new resource. However, there is limited research focusing on first contact practitioners and the process of allocating patients to them in GP Practices.

Consequences

Whilst GP practices are already implementing processes to allocate patients to FCPs in addition to GPs, existing research on this topic is sparse. Research is required to understand FCP allocation models in terms of effectiveness and its impact on patients and staff.