‘Where are we going? What are we doing?’: Reflections on the World Cafe Stakeholder Event

World cafe approach

The world cafe approach encourages inclusive discussion, shared reflection and collective problem-solving. The purpose of this particular event was to facilitate collaborative discussion around the implementation, integration, support and evaluation of additional roles within primary care settings. Attendees were a diverse group of stakeholders, including patients and public contributors, researchers, clinicians, primary care staff and representatives connected to healthcare policy and service delivery.

On the day, participants rotated between tables, enabling ideas to build progressively across discussion rounds. The format created opportunities for equal contributions to the conversation, with topics structured around four key areas (see below for more information). Each round focused on a different aspect of additional roles in primary care. Members of the research team including PPI individuals acted as table hosts, supporting and documenting conversations.

Topics discussed on the day

Round 1: Measuring success of additional roles

The first discussion focused on identifying factors to consider when assessing whether additional roles in primary care have been successful. Participants discussed outcomes relevant to patients, existing primary care staff, and those working in additional roles themselves. Key themes included:

1. Patient access to care, continuity, and satisfaction;
2. Staff workload, job satisfaction, and team wellbeing; and
3. System level success including broader health outcomes, communication of the role and expectation setting.

Participants emphasised that success should not be measured solely through appointment numbers or financial indicators, but through a holistic and clustered understanding of impact on patient experience and service quality. There was considerable discussion around public understanding and acceptance of additional roles.

Round 2: Integration within practice teams

The second discussion explored how additional roles can be better integrated within primary care teams. Participants discussed the importance of relationship-building, communication and organisational culture in supporting successful integration. Several people emphasised the need for co-location and opportunities for informal interaction between team members, as well as inclusion in multidisciplinary meetings and shared decision-making processes.

Concerns were raised around role ambiguity and inconsistency between practices. Participants suggested that clearer definitions of scope and responsibility could support integration and reduce misunderstandings within teams. Participants highlighted the importance of clearly communicating the purpose and expertise of these roles to patients, particularly where patients may expect to see a GP.

Round 3: Support needs for additional roles

Following lunch, the third round focused on support needed for those working in additional roles to provide safe and effective care. Participants consistently highlighted supervision, mentoring, peer support and ongoing professional development as essential components. There was strong agreement that staff undertaking additional roles require structured support systems, particularly during the early stages of implementation. Participants discussed the importance of protected time for learning, regular feedback and opportunities to build confidence and professional identity within practice teams. Discussions also highlighted the emotional and practical challenges associated with working across multiple practices or organisations. Participants noted that additional roles can sometimes feel isolated and disconnected without appropriate support mechanisms in place. In the absence of support, sometimes organic, bottom-up approaches emerged such as peer-to-peer WhatsApp groups to facilitate learning and connection.

Round 4: Dissemination and impact

The final discussion considered how findings from the research could be effectively disseminated and translated into practice and policy. Participants identified a wide range of stakeholders who could engage with the findings, including policymakers, commissioners, practice managers, clinicians, professional bodies and patient groups. They suggested that dissemination should use multiple formats and channels to maximise reach and accessibility. Recommendations included concise policy briefings, visual summaries, infographics, workshops, webinars, academic publications and presentations to relevant healthcare organisations and networks. A recurring theme was the importance of presenting findings in a way that is meaningful for frontline primary care staff and decision-makers. Participants emphasised that research findings should support actionable change rather than remain solely within academic settings.