Understanding the primary-secondary care interface and its impact on workforce sustainability: a realist review protocol.

BACKGROUND: The 10-year health plan for England aims to shift care from hospitals to neighbourhoods, making the interface between primary-secondary care a critical determinant of quality, safety and efficiency. The primary-secondary care interface (PSI) represents a complex space of interconnected elements containing diverse, sub-systems of activity. Workforce sustainability is a core element of PSI function. AIM: To understand how and why the UK PSI works, for whom, and under what circumstances. DESIGN & SETTING: Using a realist review approach, we will build upon an existing programme theory (PT) about GP workforce sustainability. The search will focus on evidence from National Health Service (NHS) areas facing significant workforce and socioeconomic challenges. METHOD: Following Pawson's five steps :1) locating existing theories, 2) searching for evidence, 3) document selection and appraisal ,4) data extraction and organisation of evidence 5) data synthesis. We will analyse secondary and grey literature to refine PT. Collaboration with a content expert group of individuals using and working in the system will ensure analysis is grounded in real-world experience. RESULTS: Findings will be expressed as context, mechanism, outcome configurations (CMOCs). These will provide causal explanations for how the PSI influences workforce sustainability and equity of care. CONCLUSION: The review will examine components of the PSI that facilitate a sustainable workforce. It will explore in what circumstances mechanisms support effective and equitable interventions at the PSI such as referral management and patient access. Explanations will support developing system-wide improvements, tailored to the needs of staff and patients in under-served areas .