Barriers and facilitators for community surgery in general practice / family medicine settings: a scoping review

Rising healthcare demand and costs have prompted policymakers to explore strategies for delivering appropriate care closer to patients. In Ireland, Sláintecare supports the transfer of suitable hospital activity to community-based providers, while the United Kingdom's Fit for the Future: 10-Year Health Plan promotes a shift towards community-based care. Community surgery may contribute to this transition, but successful implementation requires appropriate resources, training, governance, and collaboration. This scoping review aimed to synthesise existing evidence on barriers and facilitators influencing the delivery of community surgery in general practice.

A scoping review was conducted following Levac's revision of Arksey and O'Malley's framework. Literature searches were performed in PubMed, Scopus, and Embase for studies published between January 2015 and May 2025, in line with PRISMA-ScR guidelines. Data were charted and analysed using thematic analysis guided by Braun and Clarke's framework.

Of 1,578 identified studies, 10 were included. Three key themes emerged: [1] operational implementation [2], GP practice dynamics, and [3] patient acceptability and engagement. Barriers included time constraints, limited resources, inconsistent training, limited collaboration between primary and secondary care, and low provider confidence. Facilitators included appropriate infrastructure, structured training, organisational support and collaboration across settings.

Community surgery can be delivered safely in general practice, but implementation requires appropriate resourcing, training, governance, and collaboration. Community surgery may contribute to timely and equitable access to high-quality surgical care while reducing unnecessary demand on secondary care. Further research should explore stakeholder perspectives and long-term outcomes.