Factors influencing the implementation of general practice nurse-delivered models of care for chronic conditions: a mixed-methods systematic review to inform models of care for chronic sleep disorders

TL;DR

This study reviews factors that help or hinder the use of nurse-led care for chronic conditions in general practice, aiming to improve care for sleep disorders.

Contribution

The study develops a new framework to guide the implementation of nurse-delivered care models for chronic conditions in general practice.

Findings

Shared understanding and support from specialists facilitated the implementation of nurse-led care models.

Barriers included busy workloads, inadequate funding, and unclear nurse roles.

A revised framework (FICC-GP) was developed to better understand and support implementation factors.

Abstract

General practice nurse-delivered models of care for obstructive sleep apnoea and chronic insomnia have been investigated in response to long wait times for specialist sleep services and limited access to recommended treatments. Despite evidence of effectiveness, these models have not yet been implemented into routine care. Understanding the factors influencing implementation can facilitate translation of research evidence into practice, however no research exploring the barriers and facilitators to the implementation of general practice-delivered models of care for sleep health was identified. Therefore, a systematic review exploring the barriers and facilitators to the implementation of general practice nurse-delivered models of care for chronic conditions was conducted to inform the implementation of new models of care for chronic sleep disorders.

A mixed-methods convergent integrated systematic review. Seven databases (MEDLINE (Ovid), CINAHL (EBSCO), Embase, Scopus, Cochrane Library, Emcare (Ovid), and ProQuest Theses and Dissertations) and Google Advanced Search were searched to July 2025, to identify records reporting barriers and/or facilitators to the implementation of nurse delivered care for chronic conditions in the general practice setting. Data were extracted and mapped to a conceptual framework for the implementation of complex interventions in the primary care setting and synthesised using framework synthesis.

Eighty-five records were included in the review. It was identified that general practice staff believed that having a shared understanding about the benefits of the model of care, support from specialist staff, and compatibility of the model of care with existing work processes facilitated implementation. Busy workloads, inadequate funding models, and uncertainty about the scope of practice of nurses were barriers to implementation. Patient-related factors were identified, such as patient capability and willingness to participate, but they did not fit meaningfully into the conceptual framework. This necessitated development of an amended determinant framework for the implementation of general practice-delivered models of care for chronic conditions (Factors influencing the Implementation of models of care for Chronic Conditions in General Practice; FICC-GP).

This review provides evidence, recommendations, and a determinant framework to support the implementation of new models of care for chronic conditions in general practice. Greater consideration of patient need and motivations for engagement in chronic condition management, improved clarity about the scope of practice of general practice nurses, and co-design with general practice staff and consumers may offer greater opportunities for success when designing and delivering new models of care for chronic conditions, including chronic sleep disorders.

This review has been registered with PROSPERO (CRD42021273346).

The online version contains supplementary material available at 10.1186/s12875-025-03078-4.

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