Health and social care economies face the challenge of designing care models to deliver better value in a climate of increasing financial pressures. This is resulting in a shift towards whole system working (Ham and Walsh, 2013) and NHS England (2014) has formally introduced a programme for new models of care (Vanguards) to improve quality, outcomes and patient satisfaction. Within this, the Multispecialty Community Provider (MCP) models of care aim to provide wrap-around and coordinated services for patients, which whilst following some standard principles, will adapt to local context. The evidence base on integration of local health and social care services is variable, characterised by a lack of consensus on definitions, models and approaches; this is evident in the models developed in the 14 MCP demonstrators. Our rapid desk-based analysis of the demonstrators suggests various interventions and mechanisms at different levels (micro, meso and macro) within the system, e.g.: extensivist primary care; multidisciplinary community teams; social prescribing (interventions); community assets and social capital (mechanisms). The evidence base will provide important lessons regarding what might be considered the “active ingredients” for MCP models (Naylor et al., 2015; Cameron et al., 2014; Association of Directors of Adult Social Services, 2013; Goodwin et al., 2014; Ling et al., 2012; NHS England, 2015c).
Our aim is to provide decision makers with a practical evidence base on the MCP model of care. The synthesis will develop a conceptual framework which articulates what works, why and in what circumstances, to inform design and implementation of future iterations of the model.
We will:
- articulate the underlying programme theories behind MCP models, mapping the logic models of MCP demonstrator sites;
- identify evidence to test programme theories;
- appraise, extract and analyse evidence;
- develop the synthesis, producing a “blueprint” to explain how the mechanisms used in different contexts contribute to outcomes;
- consult with key stakeholders to validate findings and test applicability;
- disseminate findings via a series of practical tools to support knowledge mobilisation.
The synthesis will use an innovative combination of two synthesis techniques that have the potential to be harnessed together to yield unique insights: best fit framework synthesis and realist synthesis. “Best fit” framework synthesis is a rapid tool by which to facilitate the data extraction and analysis process and is “especially suitable in addressing urgent policy questions where the need for a more fully developed synthesis is balanced by the need for a quick answer” (Dixon-Woods, 2011). Best fit framework synthesis will be combined with realist synthesis principles to maximise the value of the interpretative process resulting in practicable and feasible recommendations for practice. The realist approach acknowledges that interventions do not necessarily transfer easily from one setting to another and offers deeper insights into the contextual factors involved in change. Recently methods have been proposed for rapid approaches to realist synthesis (Saul et al., 2013) and the methods proposed in this review (i.e. synthesis and analysis of logic models developed by the Vanguards and use of a best fit framework) offer an alternative systematic route to harnessing the exploratory potential of the realist lens within an accelerated timescale.
mcpsynthesis 