Table II.

Common transformation programme elements

Element	Pinnacle Midlands Health Network	Achieving Clinical Excellence	British Heart Foundation House of Care	MacMillan Cancer Improvement Partnership
External facilitation	A multi-disciplinary change management team included GPs, managers, analysts and patient partners	One pilot funded an expert in improvement methodology to guide their approach	External support was provided through the Year of Care Partnership and the Health and Social Care Alliance Scotland. Funding was used to employ project managers	Three change facilitators with nursing / primary care backgrounds were recruited to support each practice
Leadership support	Peer leadership networks and time for reflection was provided for GPs, nurses and practice manager leads	Pilot leads had time for reflection and peer challenge within learning sets	Each site identified local clinical leads to champion the new approach	MacMillan GPs helped develop standards and each practice needed a clinical and non-clinical cancer champion
On-going learning	Leadership development programmes were available	Evaluation provided emerging insights to help shape further implementation.	The Year of Care Partnership delivered training on care and support planning and also developed local trainers	Opportunity for leads to meet and reflect on progress with implementation
Stakeholder engagement	Patient forums and multi-disciplinary workshops are held	Sharing events were held for wider GP membership	Patient representatives required on national and local steering groups	A patient engagement facilitator co-ordinated various engagement opportunities
Transitional funding	One-off funding to provide backfill and meet additional expenses	Pilots received additional per capita funding for 12 months with flexibility as to how this was used	Additional funding was provided for project management/patient engagement but not backfill	Practices were offered one-off incentive payments
Robust evaluation	Progress reviewed regularly against baseline	An external formative evaluation was commissioned	An external evaluation was commissioned which also supported local evaluations by sites	An external evaluation was commissioned