General Practice Additional Healthcare Professional (AdHP) Workplace-Based Learning (WPBL): A Realist Review with SWAR and Appreciative Inquiry to Co-Produce, Implement and Evaluate an AdHP-WPBL General Practice Toolbox. Short Title: 'GAP LEAP'

Research questions How can workplace-based learning (WPBL) for additional healthcare professionals (AHPs) in general practice be delivered to facilitate a sustainable workforce and effective, equitable patient care? In particular: What is working to support AHP-WPBL? Why is it working, how, and for whom? How can this be enhanced? How can evidence and PPI/Stakeholder involvement be used to co-produce a toolbox to support AHP-WPBL in general practice? Under what circumstances does the toolkit support a sustainable general practice workforce and effective and equitable patient care? Additionally (SWAR): How can AI support future realist reviews to identify key papers and/or develop programme theory? Background General practice can provide cost-effective and person-centred universal healthcare, managing unselected and complex problems at the point of need (1). However, it is under pressure from a ‘workforce crisis’ (2), expansion of remote patient encounters and secondary care treatment backlogs. NHS strategies (3, 4) have supported general practice through AHPs, e.g. physician associates, clinical pharmacists and paramedics (5-7). Some studies show the positive value of these roles (6, 8). However, recent controversies surround WPBL arrangements including regulation, supervision, and patent safety (9-11). This project builds on existing evidence alongside patient and professional experiences. It explores impacts on AHPs, patients and GPs, and will inform future workforce planning, regulation and education. While policies seek to address GP workforce issues, some report workload challenges around AHP training/supervision alongside patient care. We will focus our sampling and analysis to explore the impact of AHP-WPBL in areas of patient deprivation; low GP numbers and/or increased AHP recruitment. Unlike hospital settings, general practice often involves unpredictable, undifferentiated illness and complex needs. It is important to understand in what circumstances AHP-WPBL can thrive in this setting to support patient care and a sustainable workforce Aims and Objectives Our project aims to address how best to support AHP-WPBL in general practice to maximise opportunities for effective and equitable patient care, and support workforce sustainability. Objectives are to: WP1: conduct an AHP-WPBL general practice realist review and SWAR WP2: conduct a realist appreciative inquiry based on WP1, integrating patient/stakeholder experiences WP3: co-produce an AHP-WPBL general practice toolbox WP4: conduct a realist evaluation to explore how the toolbox can support the general practice workforce and delivery of equitable, effective patient care Methods and Timelines WP1 (1-12m): Realist review andAI software SWARs 1,2+3 WP2 (13-16m): AppI steps 1-3 to explore and embed PPI/stakeholder perspectives about AHP-WPBL in general practice, why and how could it be enhanced? WP3 (17-22m): Co-produce toolkit (AppI step 4) WP4 (23-36m): Realist evaluation toolbox Anticipated impact and dissemination: We will submit publications/short reports about the realist review, AI SWAR, toolbox co-production, implementation, and evaluation. We will invite PPI/stakeholder to co-author. The toolbox resource will be available open access on-line. We will utilise our research team, stakeholders, and PPI established networks, alongside a toolbox dissemination event, to showcase project findings and embed the toolkit within policy, education and clinical communities.