{
  "abstract": "Objective We aimed to determine whether UCLP-PRIMROSE (a care innovation to reduce physical health inequalities for people with severe mental illness) could be set up in the current UK National Health Service (NHS) context and identify the processes, barriers and facilitators to implementation.Design We employed a convergent mixed methods approach, combining interviews, ethnographic site visits and the collection of meeting notes and uptake data for core model components. Interview transcripts were analysed using reflexive thematic analysis, and all qualitative data, including interview transcripts, were analysed using the Consolidated Framework for Implementation Research. Qualitative work and insights from implementation uptake frequencies were integrated using Normalisation Process Theory.Setting We evaluated implementation in Yorkshire and three London boroughs, mainly within general practices.Participants We conducted interviews with 39 staff members who were implementing and/or delivering UCLP-PRIMROSE.Intervention UCLP-PRIMROSE is an integrated evidence-based care pathway developed to reduce cardiovascular disease risk and mental health relapse in people with severe mental illness.Results Adaptation and delivery varied in completeness and consistency across 24 general practices and their wider care teams. Factors outside the implementation teams’ influence challenged the embedding of UCLP-PRIMROSE. Factors included the impact from the immaturity of NHS integrated care systems, unintended consequences of the incentivised NHS severe mental illness physical health check and limited capacity for implementing in a system facing resourcing challenges. Drivers of successful implementation included staff being aligned with the values of the UCLP-PRIMROSE model and system leaders acting as champions. Supportive foundational processes acted as facilitators: these included protected and prioritised time for reflection, learning and problem solving.Conclusions Implementation of UCLP-PRIMROSE was moderately successful in a relatively short period of time. At the end of the research, all teams wanted to sustain delivery. However, further pathway simplification and additional resources are required to spread UCLP-PRIMROSE beyond early pockets of good practice.",
  "authors": [
    {
      "affiliations": [
        "Division of Psychiatry, University College London, London, England, UK"
      ],
      "name": "Philippa Shaw"
    },
    {
      "affiliations": [
        "Improvement Academy, Bradford Institute for Health Research, Bradford, England, UK"
      ],
      "name": "Zuneera Khurshid"
    },
    {
      "affiliations": [
        "Department of Primary Care and Population Health, University College London, London, England, UK"
      ],
      "name": "Danielle Lamb"
    },
    {
      "affiliations": [
        "Primary Care and Population Health, Royal Free Campus, University College London, London, England, UK"
      ],
      "name": "Fiona A Stevenson"
    },
    {
      "affiliations": [
        "Bradford District Care NHS Foundation Trust, Saltaire, England, UK"
      ],
      "name": "Gregor Russell"
    },
    {
      "affiliations": [
        "Improvement Academy, Bradford Institute for Health Research, Bradford, England, UK"
      ],
      "name": "Kristian Hudson"
    },
    {
      "affiliations": [
        "Department of Primary Care and Population Health, University College London, London, England, UK",
        "UCLPartners, London, England, UK"
      ],
      "name": "Nirandeep Rehill"
    },
    {
      "affiliations": [
        "UCLPartners, London, England, UK"
      ],
      "name": "Gemma Copsey"
    },
    {
      "affiliations": [
        "UCLPartners, London, England, UK"
      ],
      "name": "Matt Kearney"
    },
    {
      "affiliations": [
        "UCLPartners, London, England, UK",
        "North London NHS Foundation Trust, London, UK",
        "Barnet Enfield and Haringey Mental Health NHS Trust, London, England, UK"
      ],
      "name": "Edward Beveridge"
    },
    {
      "affiliations": [
        "North London NHS Foundation Trust, London, UK"
      ],
      "name": "Ian Prenelle"
    },
    {
      "affiliations": [
        "Division of Psychiatry, University College London, London, England, UK",
        "North London NHS Foundation Trust, London, UK"
      ],
      "name": "David Osborn"
    }
  ],
  "title": "Bridging the gap in the UK’s National Health Service integrated care systems: insights from a mixed methods implementation evaluation of UCLP-PRIMROSE, a care innovation to reduce physical health inequalities for people with severe mental illness",
  "uid": "0d4fbfe0-4d04-5d94-b674-04c14da55eae"
}