Advanced practitioners—nurses, pharmacists, and paramedics with extra training—are now diagnosing and managing patients in GP surgeries across England, yet no one knows exactly what makes these roles work well for staff and patients. This study tackles that gap. While advanced practitioners are meant to ease the strain from GP shortages and rising patient numbers, their multi-professional nature creates confusion over regulation, supervision, and scope of practice. The researchers will interview national workforce leads, survey advanced practitioners across England, and conduct in-depth case studies at five GP surgeries in the North of England, speaking with GPs, managers, patients, and carers. They will use a realist evaluation approach to identify which conditions—such as team dynamics, training support, or role clarity—lead to effective outcomes like staff retention and good patient experience. If successful, the findings will give NHS workforce planners and GP practice managers concrete evidence on how to deploy advanced practitioners effectively, potentially improving access to care and reducing burnout in primary care teams. The results will be shared through videos, policy briefings, and academic papers.
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Research question What are the conditions that contribute to effective outcomes in multi-professional advanced practice in primary care for staff and patients? Background Advanced practitioners (APs) from a range of professional backgrounds have been introduced in primary and secondary care over the past few years across the United Kingdom (UK) and internationally. They have undertaken additional training to assess patients with undifferentiated conditions and manage complex decision-making. In primary care they are viewed as one strategy to address increasing patient numbers and a shortage of general practitioners (GPs). The multi-professional nature of AP roles and their intersection with medicine present a number of challenges, related to regulation, scope of practice, supervision, training and development. This is associated with role ambiguity among APs, their colleagues and patients. Little is known about the impact of advanced practice on interprofessional team functioning, working conditions and workload. Aim To undertake a realist evaluation of multi-professional advanced practice in primary care Objectives To develop an initial programme theory (IPT) through interviews with regional and national advanced practice leads. To refine the IPT through a survey of APs in primary care across England. To undertake case studies of GP surgeries in a range of contexts in the North of England to develop programme theories, these will be refined through workshops with key stakeholders. To disseminate the findings via academic publications, conferences, to patient groups and key stakeholders through workshops, video animations and web resources. Methods Design: realist evaluation with interviews, survey and case studies . Work package (WP) 1: Interviews will be undertaken with regional and national advanced practice workforce leads (from Integrated Care Boards (ICBs), training hubs and professional colleges) to identify challenges in supporting advanced practice. Initial programme theory (IPT) will be developed. WP 2: A survey will be sent to APs based in primary care across England to understand their professional background, identity, level of practice, experiences of support and career intentions. IPT will be refined. WP 3: Five case studies of GP surgeries in the North of England to understand advanced practice in a variety of settings. Individual interviews and focus groups with GPs, APs, managers, other clinical staff, patients and carers. We will explore how different factors impact team working, AP role identity, patient experience and staff retention. WP 4: Stakeholder workshops and relationship building for dissemination (managers, clinicians, policymakers, patients). Timeline The study will commence in July 2025 and last 34 months. Set up will take 4 months, followed by WP1 (5-9 months), WP2 (10-15 months), WP3 (15-30 months), and WP4 (29-34 months). Anticipated Impact and Dissemination New knowledge generated by this study will inform future advanced practice workforce planning and support in primary care, benefitting individual APs, their colleagues and patients. The findings will provide important insights into how different mechanisms lead to key outcomes. Findings will be disseminated through a range of activities, with involvement of our PPIE group and stakeholders; videos for public/patients, briefing documents for key stakeholders, academic publications, lay summaries and conference presentations.
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