Table 1.

Details of the final iteration CARE Plus intervention.

Intervention aspects		Details:
		In this paper	Other/comments
Intervention name	CARE Plus: a primary-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation.	This paper describes the development and optimisation of the intervention and the final iteration to be tested in a phase 2 exploratory RCT.	This work is part of a 4-year programme of research called ‘Living Well with Multimorbidity’ funded by the Chief Scientis Office of the Scottish Government NHS Applied Research Programme Award (ARPG07/01).
WHY (theory, background, essential elements)	Likely key components drawn from literature, expert opinion, and views of patients, representatives and health care staff.	This papers outlines the background to the research and how the key components of the CARE Plus intervention were identified and developed.	See Bamett et al.2 and O’Brien et al.,7,8 for details of the baseline epidemiology and qualitative research that informed the intervention development.
WHAT (materials)	Longer consultations using bespoke CARE Plus care plan; practitioners training and support materials; patient self-management support materials.	The key components of the intervention are presented in the paper and the final iteration is outlined under the ‘optimisation section.’ In the pilot, a variety of CBT-based booklets were given to different patients. Mindfulness-CDs were not available at the time of the pilot.	A final version of the CARE Plan will be developed for the RCT. The final version of the materials given to practitioners in the training days and to the patients in the RCT will be developed before the RCT begins, informed by the current findings of this paper. The patient self-management support pack requires further development before the RCT.
WHO will provide intervention	CARE Plus consultations Practitioner training and support	This paper identified the need for flexibility in terms of who delivers the intervention (GP or PN) and that different practices will be allowed to operationalise this differently.	The practitioner training and support in the pilot study was delivered by an academic GP (SWM) and a psychiatrist skilled in CBT and mindfulness. This will also be the case in the exploratory trial.
HOW (modes of delivery)	Patient consultations will be face-to-face with GP or PN Practitioner training will be group based.	In the pilot study the CARE Plus consultations were all held face-to-face.	In the exploratory trial, practitioners will deliver the consultations face-to-face for reasons of efficiency.
WHERE (locations)	Patients consultations Practitioner training and support.	In the pilot study almost all the consultations were delivered in the practices. Practitioner training and support was only delivered in one practice, and this took place in the practice.	In the exploratory trial consultations will take place in the practices. Group training and support will involve all GPs and PNs in the intervention group meeting 3–4 times over 12 months in a single location.
WHEN and how much	Number of CARE Plus consultations per patients. Practitioner training and support meetings: maximum 4 meetings; 3 h per meeting. Patient self-management support material.	In the current paper, it was clear that the length of the consultations required was contested in the development phase; however, in the pilot in the 2 practices, it was agreed that the initial consultation needs 30-40 min and the follow-up 20-30 min. The number of follow-up consultations required was not established. In this paper, only 1 practice took part in the training and support and had only 1 meeting of 3 h.	In the exploratory trial we will recommend that practitioners see the selected patients in the CARE Plus intervention at least twice, and that the initial consultation will require 30–40 min and follow-up 20–30 min. Further follow-up consultations will be at GP/PNs discretion depending on patients’ needs and progress, as in the pilot. Practitioner training and support meetings: In the RCT we will aim for 3–4 meetings, 3 h per meeting, over the 12 months of the trial. Patient self-management support pack will be given to patients by the practitioners and used at the patients’ own discretion.
Tailoring	GPs/PNs allowed flexibility to tailor to patients’ needs but core components essential.	As above, the core ingredients as described in the paper are fixed but discretion is allowed as to who delivers, and how often.	As above
Modifications	To CARE Plus consultations, practitioner training and support and/or patient self-management pack.	Several modifications were made during the development and optimization as outlined in this paper	Further modifications required before exploratory RCT as above.