Review sub-finding 5c: Decision to keep patients on the caseload One study looked at care networks of patients with advanced heart failure. It found that specialists describe their decision to take over someone s care in the HF clinic as being based on patient need (primarily from the CHF perspective) and the perceived ability of the general practitioner to fulfil these needs. The paper shows though, that actual practice varied widely, and the research team reflect that: complexity [of the patient] interacted with the health care providers perspective, comfort level and available resources to influence referral and consultation practice p372 325 Another study also reflected this, where some HF professionals acknowledged the GPs importance in ensuring continuity of care, but took over care despite of this because they doubted the ability of the GPs to manage heart failure. This sub-finding was based on 2 studies202, 325 . Methodological limitations were rated minor overall. One paper was rated as moderate limitations, and one as minor limitations with the latter contributing more to this sub-finding. Coherence was rated no or very minor concerns overall. It fits with other sub-findings, in that the decision about where CHF patients are best managed has a number of objectives, which can conflict. Relevance was rated moderate concerns overall. The relevance of this sub-finding to the focus of the review was high from a staff experience point of view. Concern was due to one study being from outside the UK, however, the second (UK-based) study was conducted in a number of locations, which supports this being a relevant and generalisable theme. Adequacy was rated as moderate concerns. The finding was specific, but there were still an inadequate numbers of studies. This sub-finding was both descriptive and explanatory, and there was plenty of detail in the papers. 