Primary care micro-teams: a protocol for an international systematic review to describe and examine the opportunities and challenges of implementation for patients and healthcare professionals

Introduction: 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 to mitigate some of the potential challenges with practice expansion, including continuity of care. We aim to review the available literature to improve understanding of how micro-teams are described and the opportunities which primary care micro-teams can provide for practice staff and patients and limitations to their introduction and implementation. Our review asks: how is micro-team implementation described? What are the experiences of healthcare professionals and patients concerning micro-teams in primary care? What are the reported implications of micro-teams for patient care? // Methods and analysis: CINAHL, Cochrane Library, Embase, MEDLINE and Scopus will be searched for studies in English. Grey literature will be sourced from Google Scholar, government websites, CCG websites, general practice directives and strategies with advice from stakeholders. Included studies will give evidence regarding the implementation of micro-teams. Data will be synthesised using framework analysis. We will use iterative stakeholder and public and patient participation to embed the perspectives of those whom micro-teams could impact. Included studies will be quality assessed using the Mixed Methods Appraisal Tool. The quality assessment will not be used to exclude any evidence but rather to develop a narrative discussion evaluating included literature. // Ethics and dissemination: Ethical approval will not be necessary for this systematic review as there will only be a secondary analysis of data already available in scientific databases and the grey literature. This protocol has been submitted for registration to be made available on a review database (PROSPERO). Findings will be disseminated widely through peer-reviewed publication and in various media, for example, conferences, congresses or symposia

Opportunities, challenges and implications of primary care micro-teams for patients and healthcare professionals: an international systematic review

Background: There has been a recent trend, both in the UK and internationally, towards creating larger primary care practices with the assumption that interdisciplinary teams can increase patient accessibility and provide more cost-effective, efficient services. Micro-teams have been proposed to mitigate some of the potential challenges with practice expansion, including continuity of care. / Aim: Review the available literature to examine how micro-teams are described and the opportunities which primary care micro-teams can provide for practice staff and patients and limitations to their introduction and implementation. / Design and setting: International Systematic review of studies published in English. / Method: A Framework analysis was used to synthesise the literature. Databases and grey literature were searched. Studies were included if they provided evidence regarding the implementation of micro-teams in primary care. We worked with a PPI co-author and conducted stakeholder discussions to those with and without experience in micro-team implementation. / Results: The majority of the 24 included studies discussed empirical data from healthcare professionals, describing the implementation of micro-teams. Results include the characteristics of the literature; how micro-teams have been described; the range of ways micro-teams have been implemented; reported outcomes and experiences of patients and staff. / Conclusion: The organisation of primary care has the potential to impact the nature and quality of patient care, safety and outcomes. This review contributes to current debates surrounding care delivery and how this can impact the experiences and outcomes of patients and staff. The analysis identifies several key opportunities and challenges for future research, policy and practice