Realist evaluation of multi-professional advanced practice in primary care (REMAP): study protocol

Area of Science:

• Health Services Research
• Workforce Development
• Primary Care Management

Background:

• Advanced practitioners (APs) are increasingly vital in English primary care to combat workforce shortages.
• Current implementation, regulation, and scope of AP roles show significant variation.
• Limited understanding exists regarding the impact of APs on healthcare organization, staff, and patients.

Purpose of the Study:

• To investigate the contextual factors and mechanisms influencing advanced practice implementation outcomes in primary care.
• To develop evidence-based recommendations for optimizing advanced practitioner roles and supporting workforce development.

Main Methods:

• A realist evaluation employing mixed methods across four work packages in English primary care.
• Data collection involved semi-structured interviews, online surveys, case studies with staff and patients, and stakeholder workshops.

Main Results:

• Analysis of interviews with AP workforce leads (n=15) and surveys of APs (n>300) informed the initial programme theory.
• Case studies in five GP practices, including interviews with staff (n=10) and patients (n=5), further refined the theory.
• Stakeholder workshops facilitated the translation of findings into actionable policy and practice recommendations.

Conclusions:

• The study provides crucial insights into the effective implementation of advanced practice in primary care.
• Recommendations will support workforce development, enhance patient experiences, and improve overall health outcomes.