Delivering genomic medicine in the United Kingdom National Health Service: a systematic review and narrative synthesis

Purpose
We sought to assess the readiness of the United Kingdom National Health Service to implement a Genomic Medicine Service. We conducted a systematic literature review aimed to identify what is known about factors related to the implementation of genomic medicine in routine health care and to draw out the implications for the UK and other settings.

Methods
Relevant studies were identified in Web of Science and PubMed from their date of inception to April 2018. The review included primary research studies using quantitative, qualitative or mixed methods, and systematic reviews. A narrative synthesis was conducted.

Results
Fifty-five studies met our inclusion criteria. The majority of studies reviewed were conducted in the US. We identified four domains: 1) systems; 2) training and workforce needs; 3) professional attitudes and values; and 4) the role of patients and the public.

Conclusion
Mainstreaming genomic medicine into routine clinical practice requires actions at each level of the health care system. Our synthesis emphasised the organisational, social and cultural implications of reforming practice, highlighting that demonstration of clinical utility and cost effectiveness, attending to the compatibility of genomic medicine with clinical principles and involving and engaging patients are key to successful implementation.