Understanding and improving compound pressures in general practice: a realist review protocol

Journal article

Background: Compound Pressures (CP) significantly impact the role of General Practice (GP) in supporting human health. These pressures include climate change, pandemics, and financial crises. CP can be predictable, pre-determined, or unpredictable in nature and scope. Strategies to address the demands arising from CP range from short-term initiatives to buffering existing GP systems to ensure flexible and agile resources. Interventions designed to prevent, identify, and manage CP may result in both intended and unintended outcomes.

Aim: To conduct a realist appreciative inquiry, realist review, and three embedded studies within a review (SWAR) about CP affecting GP and the delivery of effective, equitable patient care.

Design & setting: Realist appreciative inquiry, realist review, and three SWARS.

Method: We will conduct a realist appreciative inquiry facilitating patient and stakeholder input into the review scope, focus, and initial programme theory development. This approach emphasises the identification of assets, successes, hopes, and aspirations to enable positive change. Based on these insights, we will conduct a realist review of empirical and grey literature. This project includes three elements of methodological innovation (SWARs). First, evaluation of how appreciative inquiry can inform initial programme theory development. Two further SWARs will examine how artificial intelligence might a) support the identification of relevant resources at title and abstract, and full-text stages, and b) support data extraction and analysis in future realist reviews.

Conclusion: Our research aims to understand the effects of CP on GP, supporting preparation and solutions that can inform future policies, interventions, and support systems.

Authors: Owen-Boukra, E; Abrams, R; Cohen, T; Goodman, C; Henry, C

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Royal College of General Practitioners
• Journal: British Journal of General Practice Open
• Place of publication: England
• Publication date: 2025-10-01
• Acceptance date: 2025-07-12
• DOI: 10.3399/bjgpo.2025.0073
• EISSN: 2398-3795
• Pmid: 41034144
• Language: English
• Keywords: compound pressures; general practice; realist review