Table 1.

Details of the reviewed papers

Author, year	Aim	Study design	Sample	Limitations	Intervention	Measure	Outcomes
Agius, 2010¹⁶ (Depression)	To bring together all the studies on shared or collaborative care in depression	Narrative review of trials, systematic reviews, meta-analyses until mid-2009; description of a shared care service for depression in Luton		Mostly limited to studies carried in the USA	Shared collaborative care with primary and secondary care doctors (training of GPs in the treatment of depression and the provision in primary care of a nurse specialist or another professional to impart psycho-education, ensure concordance with medication and provide psychotherapy)Luton shared care service – training of staff and funding to deliver service	Depression outcomes and cost benefits	Improved treatment outcomesIncreased doctor and patient satisfactionSome cost benefits despite increased immediate costsLuton service dissolved due to lack of funding (a cost saving measure)Stepped model for treatment of depression is focusing on facilitation of access to secondary care and discharge back to primary care, rather than focusing on optimising outcomes of care
Ahmed, 2014²⁸ (Patient safety)	To determine the views of general practice educational supervisors (GPES) regarding the qualities and attributes of a safe GP and the perceived trainability of these safety skills and to compare the results with those generated by a study of hospital doctors	A prospective survey of all GPES in Scotland	50% of GPES completed the survey
Bernstein, 2011²⁴ (Musculo-skeletal conditions)	To determine how GP consortia can lead the development of integrated musculoskeletal services	Description of the service redesign process; pre- and post-processes and outcomes measures	Ealing interface service including all GP practices	No control group	‘See and treat’ interface clinic model – most patients being managed in primary care and fast routes to secondary careInterface service to provide expertise in diagnosis, triage and management of musculoskeletal problems not requiring surgeryBundle of interventions when developing integrated service:> GP consortia leading an integrated service> GP consortia deliver service redesign by coordinating primary care development, local commissioning of community services and the acute commissioning vehicles responsible for secondary care> GP consortia with strong clinical leadership, inbuilt organisational and professional learning	Interface performance indicators:> community treatment> outpatient attendances> surgical conversion rates	86% of patients presenting to GPs managed in primary care and community settingsA fall in specialist opinions occurring in secondary care from 100% in 2005 to 73% in 2010The surgical conversion rate for onward referral from the interface service is 70% compared with 30% from GP referrals direct to secondary care10% reduction in GP referrals into the secondary serviceInappropriate referrals to secondary service dropping to 1%A saving of £1 million recurrent per year
					> input into commissioning by a dedicated commissioner, the core strategy group, the practice-based commissioning leads, primary care trust (PCT) commissioning the community provider
					> Primary care trust clinical advisor liaising with those inputting into commissioning to ensure coherent commissioning
					> a GP champion
					> high profile GP education programme with appointed education lead
					> referral guidance
					> block contract
Campbell, 2004¹⁸ (Mental health services)	To evaluate the effects of PMS on the quality of primary mental health between 1998 and 2001	Multiple longitudinal qualitative case studies; semi-structured interviews with the key staff within practices (GPs, practice nurses, practice managers) and outside managers (health authority and primary care group/trust); context-mechanism – outcome model of organisations used to do the analysis	A purposive sample of six first wave PMS sites which had specifically planned to improve their mental healthcare; a diversity of aims relating to mental healthcare	Limited data sources without patient evaluation, analysis of prescribing indicators, hospital admission and referral rates	Each pilot site presented a diversity of aims relating to MH care with PMS being introduced across the sites; three sites had a specific focus on mental health, two incorporated MH objectives into a wider quality agenda and one addresses MH as part of a health education programmeThe sites varied regarding the role of PMSMechanisms: named mental health leads leading the pilot, additional resources to fund new clinical posts, working towards PMS targets, links with voluntary sectors, links with secondary care, links with local authority, teamwork, protocols, guidelines and procedures	Aims and targets for each pilot site	Successful quality improvement was associated with effective collaboration with community and secondary care; new contractual arrangement (PMS) but contractual changes were not in themselves sufficient to improve care but had to be accompanied by five mechanisms: clear goals, effective teamwork within the practice, routine use of protocols and audits, additional resources, effective collaborationNo difference between practice or trust led initiativesNo single effect of the new contractual arrangement (PMS)
England, 2005¹⁷ (Mental health services)	To examine effects of healthcare policy on the development of integrated mental health services in England	Case studies of the primary/secondary interface for people with serious mental illness	Three case studies drawn from a narrative review of literature (1997–2003)	Abstract case studies	Horizontal integration in primary careHorizontal integration in secondary careVertical integration across the interface between primary and secondary care		An integration rhetoric/reality gap in practice
Featherstone, 2012²⁹ (Diabetes)	To understand how an integrated electronic health record system was used by healthcare staff in the treatment and management of diabetes patients	Observational study of the use of an integrated EHR during patients’ consultations with healthcare staff conducted over 3-month period	Twelve patients (nine from surgeries using EHR and three from surgeries not using EHR) were followed through 31 consultations	No information on selection process of patients	Setting up and using a shared EHR between primary and secondary care		Not all HCPs used the EHR; EHR can support more integrated care; unresolved issues in implementing the system across all services and settings highlight the governance problems when systems are developed locally but are then extended across organisational and professional boundaries
Hull, 2014²² (COPD)	To evaluate a system change to enhance COPD care delivery in a primary care setting	Quality improvement programme; observational study using routinely collected data between 2010 and 2013	Thirty-six GP practices (all practices) in Tower Hamlets PCT; all patients with spirometry values indicative of COPD	Practices not randomised to the intervention; other factors may have affected primary care management of COPD during the period of interventionUncertainty between the intervention and the observed outcomes	Collaborative working between practices (networks)Shared financial incentivesEngagement between primary and secondary cliniciansInvestment:> financial investment> organisational investment	Care package key performance indicators:> number of COPD cases on network registers> number of care plans completed in the previous 15 months> number of referrals to community-based pulmonary rehabilitation> annual influenza immunisation> smoking cessation> emergency hospital admission for COPD	Increase by 21% in identification of COPD casesIncrease by 33.5% in completed care plansIncrease by 25% in pulmonary rehabilitation referralsIncrease in rates of annual flu immunisationSmall increase in smokingFall in the emergency admissions
					> behaviour change: IT-driven performance feedback, educational facilitation, financial performance incentives
McHugh, 2013²⁰ (Diabetes)	To examine the barriers to, and facilitators in, improving diabetes management from the general practice perspective, in advance of the implementation of an integrated model of care in Ireland	Qualitative design using semi-structured interviews	Purposive sample of 29 practitioners and two practice nurses nominated by the practices as the lead healthcare professional responsible for diabetes; participants represented the diversity of diabetes care arrangements in Ireland	Only primary care perspective, mostly of the GPs
O’Connor, 2013²¹ (Diabetes)	To explore GPs’ and practice nurses, perceptions of barriers and facilitators to the proposed transfer of diabetes care to general practice	Qualitative descriptive design with focus groups	Fifty-five GPs and 11 practice nurses in five focus groups representing urban, rural and mixed practices in the Irish mid-west region; fully or partly computerised	Sampling: participants were volunteers interested in participating in a discussion on diabetes care; participants from one region only but good GP and practice profile representation
Pinnock, 2009²³ (COPD)	To explore the current and planned respiratory services and the roles of people responsible for change	Semi-structured interviews with the person responsible for driving the reconfiguration of respiratory services	A purposive sample of 30 primary care organisations in England and Wales representing a wide spectrum of attitudes to the reconfiguration of respiratory services; geographical spread with a range of population size and demography	Sampling participants were interested in developing respiratory service; only one person from the PCO interviewed; limited inference about the direction of the observed relationship between clinical engagement and breadth of service provision, and the impact of confounding factors
Price, 2014²⁵ (Cardiovascular disorders)	To discuss evidence on approaches to shifting care from secondary to primary care	A discussion paper
Rea, 2007²⁷ (Chronic conditions)	To share experiences of chronic care management in Counties Manukau, New Zealand	Comparative reflections on the chronic care management and integrated care projects around New Zealand and the UK
Rushfort, 2016¹⁹ (Diabetes)	To synthesise qualitative evidence on primary care physicians’ and nurses’ perceived influence on care	Qualitative systematic review of 32 studies	MEDLINE, Embase, CINAHL, PsycInfo, ASSIA databases searched from 1980 until March 2014 inclusive of English language studies
Syriogiannis, 2015²⁶ (Glaucoma)	To describe the pattern of glaucoma service delivery in Scotland and identify areas for improvement	A glaucoma survey questionnaire sent to all consultant glaucomatologists in Scotland with 13 out of 16 responding

COPD = chronic obstructive pulmonary disease; EHR = electronic health record; GPES = general practice educational supervisor; HCP = healthcare professional; MH = mental health; PCO = primary care organisation; PCT = primary care trust; PMS = personal medical services contract