England and Scotland are testing different ways to bring new healthcare staff—such as physician associates, paramedics, and pharmacists—into GP surgeries, and this study will compare which approach works best for patients and doctors. Both countries face the same problem: rising patient demand and overworked GPs. But they have taken different paths. England funds and deploys these new roles through Primary Care Networks, while Scotland uses Health and Social Care Partnerships. No one has yet systematically compared how these different systems affect staff morale, patient experience, GP workload, or the quality of care. Over 26 months, researchers will map the regional structures, conduct case studies in six sites (interviewing 120 staff and 90 patients), and analyse electronic health records and workforce data. They will measure whether new roles improve continuity of care and reduce re-consultations, and whether GPs feel less burdened. If successful, the study will produce an "if-then" guide for healthcare organisations—telling them which employment and deployment models lead to better outcomes. For policymakers, it will offer evidence-based recommendations on how to integrate new roles without harming patient relationships or overloading existing staff.
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Background: Expanding the range of healthcare professionals in primary care, including introducing new roles and extending existing ones, has become a key strategy for managing increasing patient demand and reducing GP workload pressures. This study will explore the impact of different implementation approaches in England and Scotland. While both nations aim to alleviate GP workload and improve patient access, they vary in funding, employment models, and deployment of new/extended roles staff. This comparative analysis will examine the impact of these variations on staff experiences, patient care and experiences, and GP workload and satisfaction. Aim: To investigate the impact of different system structures and organisational processes in integrating new/extended roles on staff and practice experiences, patient care and experiences and GP workload and job satisfaction, comparing England and Scotland. Objectives: 1. To map the system structures and organisational processes through which new/extended roles staff are employed and deployed in England and Scotland. 2. To examine the impact of different approaches to integrating new/extended roles on staff and patient experiences. 3. To assess the extent to which employing new/extended roles staff improves patient care (in terms of continuity of care and re-consultations) and reduces GP workload. 4. To develop policy recommendations and implementation guidance. Methods: This mixed-methods study will employ the Consolidated Framework for Implementation Research (CFIR) to guide data collection and analysis. The study will be conducted over 26 months across four Work Packages (WPs): • Project set-up and ethics approval (Months 1-3). • WP1 (Mapping)(Months 1-6): : In-depth interviews with strategic level staff in England and Scotland (n=30) to develop a taxonomy of regional infrastructures for employing and deploying new/extended roles staff. • WP2 (Case study)(Months 7-23): Qualitative case studies in 6 sites (4 English PCNs and 2 Scottish HSCPs) to examine staff and practice experiences (WP2a) and patient experiences (WP2b) through observations/shadowing, and in-depth semi-structured interviews (n=120 staff, n=90 patients). • WP3 (Quantitative analysis)(Months 3-23): Analysis of electronic healthcare records and administrative workforce data to assess patient outcomes (continuity of care and re-consultations - WP3a) and GP Worklife Surveys to assess GP workload and job satisfaction (WP3b). • WP4 (Integration & Dissemination)(Months 24-26): Integration of quantitative and qualitative findings to develop policy recommendations and implementation guidance. Impact & dissemination: We will set up a Knowledge Exchange Network (KEN), which comprises members of the Project Advisory Group and PPI Groups, to support our dissemination. This network will serve as a link between our study and relevant stakeholder organisations and also ensure that we are aware of emergent developments/challenges where they might inform the study. We will produce outputs for different audiences: • Healthcare organisations - "if-then" guide with actionable recommendations. • Policymakers - working with Policy@Manchester to produce policy briefs. • Professional organisations - presentations at for e.g. the Royal College of General Practitioners, Scottish Deep End conference, NHS Confederation. • Academic - publication of at least four peer-reviewed articles. • Wider dissemination - infographic and animation.
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