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

Background The introduction of advanced practitioners (APs) is one approach to addressing health and care workforce shortages, with around 6000 APs working in primary care in England. There is variation in implementation, regulation, and scope of the role, and limited knowledge on implications of their implementation on workforce organisation, staff and patients. There is a pressing need for research to understand what works in advanced practice implementation, for whom and in which contexts.

Aim To understand the contexts and mechanisms that influence key outcomes in the implementation of multiprofessional advanced practice in primary care in England and develop recommendations to support workforce development.

Design & setting A realist evaluation using mixed methods across four work packages in primary care in England, incorporating research with advanced practice workforce leads, APs, key primary care staff (clinical and management), and patients and carers.

Method The following approaches will be taken: i) semi-structured interviews with advanced practice workforce leads in England to inform the development of an initial programme theory (IPT) (n=15); ii) online survey of APs in England to refine IPT (n>300); iii) case studies in five GP practices in England, interviewing staff members (n=10), conducting interviews or focus groups with patients (n=5) and gathering documentary data (to test and modify the IPT); iv) stakeholder workshops to share findings and develop policy and practice recommendations.

Conclusion Findings will be used to inform recommendations for the implementation of advanced practice in primary care, to support workforce development, enhance patient experience and improve health outcomes.