Assessing the introduction of the expert patients programme into the NHS: a realistic evaluation of recruitment to a national lay-led self-care initiative

The study objective was to explore the way in which the expert patients programme (EPP) has been implemented by primary care trusts (PCTs) and to identify key barriers and facilitators to the implementation of this initiative in the National Health Service (NHS). The study forms the first part of a process evaluation to record the development of the EPP in the NHS and to identify the patterns of development which impact on NHS organizations and local community partnerships and networks. This preliminary survey consisted of telephone interviews with the key personnel working in primary care sites where EPP was initially piloted. Forty-six PCT leads (74% of those eligible) and 19 EPP trainers were interviewed (68% of those eligible). Secondary sources of data (such as PCT websites and literature promoting the EPP courses) were also examined. The PCTs’ ability to recruit to EPP courses was considered a key marker of early success which in turn related to wider issues concerning EPP’s position in the PCT’s priorities and the degree to which it was seen or made to link with other agendas and goals. A quarter of the sample had good rates of recruitment, the characteristics associated with these sites included: location in urban areas; early access to voluntary tutors; delegation of administrative responsibilities; networking and sharing resources with other PCTs; use of local newspapers to publicize courses; and active support from health professionals. Problems with recruitment were associated with a reliance on a paper-based strategy; poorly developed links to the broader community and health professionals. The evaluation shows that initial success of a lay-led self-care support programme in the NHS depends on commitment at the level of the PCT boards as well as those directly charged with organizing and delivering pilot training courses. Helping key health professionals understand and engage with the principles and benefits of training in self-care for people with long-term health conditions is likely to impact on the success and future of this programme within the NHS.