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Additional file 5. Defining the groups based on LARC use, events related to planning a pregnancy andcontrary events, and conception.

Additional file 1. Defining LARC events using (a) read codes and (b) BNF prescription codes.

Additional file 3. Assumptions agreed by the Plan-it study team in advance.

Additional file 2. Clinical codes.

Additional file 1:. SPIRIT 2013 Checklist

Additional file 2:. The TIDieR (Template for Intervention Description and Replication) Checklist

Additional file 1. Key informant interview questions.

Aims/Objectives/BackgroundWe aim to describe and classify the predominant streaming pathways on arrival in Emergency Departments (EDs) in England and Wales and explain how they operate in different models of emergency department primary care services. Recent policy has encouraged a method whereby nurses stream from the emergency department front door to GPs working in a separate GP service operating within or alongside an ED. However, there is variation in methods of assessing and streaming patients on arrival at EDs. Conflated terminology causes difficulties in assessing relative performance, improving quality or gathering evidence about safety, clinical effectiveness. Our findings present a new classification of current streaming pathways from emergency departments to primary care services.Methods/DesignWe used a multi-stage method approach, including an online survey completed by 77 EDs across England & Wales, interviews with 21 clinical leads, and finally, undertaking case studies of 13 EDs. Qualitative data were triangulated and analysed using a framework analysis approach.Results/ConclusionsThe most common ED pathways to primary care services were: front door streaming before ED registration; streaming inside the ED; or without streaming but GPs selecting patients. Pathways were often adapted, to suit local circumstances such as department layout, patient demand levels, skill mix and interests of GPs practitioners and the accessibility of community primary care services. Pathways to redirect patients with non-urgent primary care problems to community primary care services were also used, with local variation in protocols based on staffing, patient demand and links to community primary care services. Local clinical leads and managers need to consider which pathway(s) may best suit their local context and needs. Consistency of terminology used to describe pathways between EDs and primary care services is necessary for multi-site evaluation, quality improvement and performance measurement.

In May 2018 the new All Wales Social Prescribing Research Network (WSPRN) funded by the Wales School for Social Care Research (WSSCR) convened a consensus meeting with key individuals from practice, academia, government, statutory and the third sector organisations to set its research priorities for Wales. The meeting was co-chaired by Judith Stone, WCVA and Dr Carolyn Wallace, University of South Wales & PRIME Centre Wales. It subsequently conducted a consultation process with its 170 members and the PRIME Centre Wales SUPER group (members of the public)to reach a final consensus and agree a way forward. This document reports on these events. The WSPRN is a multi-agency and multi-disciplinary organisation led by WCVA and USW. Its aim is to build the critical evidence for social prescribing in Wales. It supports the South, North and West Wales communities of practice and also feeds into RCE Cymru (a Regional Centre of Excellence within the United Nations University Institute for the Advanced Study of Sustainability global network).

Introduction \ud Supporting self-management among people with long term conditions is recognised as an important component of health care. Progressive neurological conditions (PNCs), for example, Parkinson’s disease and Multiple Sclerosis are associated with problems such as fatigue and cognitive impairment which may make self-management more challenging. Health professionals may need to develop specific skills in order to provide effective self-management support for these patients. The review aims to develop explanatory theories about how health professional-targeted interventions to improve self-management support provision for people with PNCs operate in different circumstances. \ud \ud Methods and Analysis\ud A realist synthesis of the evidence is proposed. There are two priority questions for the review to address. These relate to the role of a shared concept of self-management support within the healthcare team, and the need to tailor the support provided to the requirements of people with PNCs. Key stakeholders will be involved throughout the process. The initial search strategy uses terms relating to 1) self-management, 2) health professionals and 3) PNCs. Searching, data extraction and synthesis will occur in parallel. Studies will be prioritised for inclusion based on anticipated contribution to generating explanatory theories. Key informant interviews are planned to direct supplementary searches and help further refine the theories developed. Results will be expressed in the form of context-mechanism-outcome configurations. \ud \ud Dissemination \ud Publication guidelines on realist synthesis will be followed. The results will be published in a peer-reviewed journal and made available to organisations involved in the provision of health professional training.

Background: Identifying the transition from relapsing-remitting to secondary progressive multiple sclerosis (SPMS) can be challenging for clinicians. Little previous research has explored how professionals experience working with patients during this specific stage of the disease. We explored the experiences of a group of multidisciplinary professionals who support patients in the transition to SPMS, to describe this stage from a professional perspective.\ud \ud Methods: Qualitative semistructured interview study with 11 professionals (medical, nursing, and allied professionals; both specialists and generalists) working with patients with MS in South Wales, United Kingdom. Thematic analysis of the interview data was performed.\ud \ud Results: Two overarching themes were identified: the transition and providing support. The theme “transition” comprised issues related to recognizing and communicating about SPMS. Uncertainty influenced both recognizing the transition and knowing how to discuss it with patients. “Providing support” included descriptions of challenging aspects of patient care, providing support for carers, utilizing the multidisciplinary team, and working within service constraints. Providing adequate psychological support and engaging patients with self-management approaches were seen as particularly challenging.\ud \ud Conclusions: Caring for patients in the transition to SPMS generates specific challenges for professionals. Further research on health-care interactions and patients'/professionals' experiences around the transition phase may help to identify strategies for professional development and learning, and how to optimize patient experience at this difficult stage of disease.