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

Background Compound pressures (CP) impact the role of general practice 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 general practice 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 general practice 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 (IPT) 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 IPT 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 general practice, supporting preparation and solutions that can inform future policies, interventions, and support systems.