The effect of general practice team composition and climate on staff and patient experiences: A systematic review.

BACKGROUND: Recent policy initiatives seeking to address the workforce crisis in general practice have promoted greater multi-disciplinarity. Evidence is lacking on how changes in staffing and the relational climate in practice teams affect the experiences of staff and patients. AIM: To synthesise evidence on how the composition of the practice workforce and team climate affect staff job satisfaction and burnout, and the processes and quality of care for patients. DESIGN & SETTING: This is a systematic literature review of international evidence. METHOD: Four different searches were carried out using MEDLINE, Embase, Cochrane, CINAHL PsycINFO and Web of Science. Evidence from English language papers from 2012-2022 was identified, with no restriction on study design. PRISMA guidelines were followed and data were synthesised thematically. RESULTS: Eleven studies in primary healthcare settings were included, ten from US integrated healthcare systems, one from Canada. Findings indicate that when teams are understaffed and work environments are stressful, patient care and staff wellbeing suffer. However, a good relational climate can buffer against burnout and protect patient care quality in situations of high workload. Good team dynamics and stable team membership are important for patient care coordination and job satisfaction. Women physicians are at greater risk of burnout. CONCLUSION: Evidence regarding team composition and team climate in relation to staff and patient outcomes in general practice remains limited. Challenges exist when drawing conclusions across different team compositions and definitions of team climate. Further research is needed to explore the conditions that generate a 'good' climate.