Enhancing understanding of interventions to increase relational continuity in general practice: a realist review protocol

Background Relational continuity of care (RCC), which is characterised by an ongoing therapeutic relationship between patients and their primary care providers, is critical for ensuring high-quality care in general practice. Despite its importance, challenges such as staffing shortages, policy shifts, and evolving patient needs often impede its consistent delivery. With the new GP contract in England highlighting the need for primary care providers to monitor and deliver relational continuity, it is more than ever crucial to understand how best to achieve it.

Aim This realist review aims to explore how, why, and under what conditions interventions to improve relational continuity are successfully implemented in general practice.

Design & Setting The review will be supported by an expert stakeholder panel and a patient advisory group to consider the diverse and dynamic settings of general practice, and generate contexts, mechanisms and outcomes configurations exploring how interventions to enhance RCC in general practice work.

Method Through the synthesis of diverse international evidence sources, including qualitative, quantitative, mixed-methods studies, and grey literature, the review will develop an understanding of the mechanisms that produce relational continuity, the contexts in which these mechanisms operate, and the outcomes they produce for the health system, practices, practitioners, and patients.

Conclusion The findings will provide data to inform future research and refine strategies and policies that support the effective delivery of relational continuity, which in turn may lead to improved patient outcomes and enhanced care experiences.