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This study found no consistent evidence of improvements in patient outcome or experience, and complex effects on the workforce, with service implementation highly subject to local context and microlevel influences.

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Jonathan Benger 1,*, Heather Brant 1, Arabella Scantlebury 2, Helen Anderson 2, Helen Baxter 3, Karen Bloor 2, Janet Brandling 1, Sean Cowlishaw 4, Tim Doran 2, James Gaughan 2, Andrew Gibson 1, Nils Gutacker 2, Heather Leggett 2, Dan Liu 5, Katherine Morton 1, Sarah Purdy 3, Chris Salisbury 3, Anu Vaittinen 6, Sarah Voss 1, Rose Watson 6,7, Joy Adamson 2

1 School of Health and Social Wellbeing, University of the West of England, Bristol, UK
2 Department of Health Sciences, University of York, York, UK
3 School of Social and Community Medicine, University of Bristol, Bristol, UK
4 Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
5 University of Technology Sydney, Sydney, NSW, Australia
6 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
7 Medialis Ltd, Banbury, UK
* Corresponding author Email: jonathan.benger@uwe.ac.uk

Declared competing interests of authors: Jonathan Benger reports that, during the early stages of the project, he was the National Clinical Director for Urgent and Emergency Care at NHS England (London, UK) (2013–19) and that, during the final stages of the project, he was the Interim Chief Medical Officer at NHS Digital (Leeds, UK) (2019–present). Sarah Purdy is a member of the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research (HSDR) Funding Committee (2019–present). Joy Adamson is a member of the NIHR Health Technology Assessment (HTA) Commissioned Calls Funding Committee (2019–present). Helen Baxter reports employment by the NIHR Centre for Dissemination and Engagement outside the submitted work. Rose Watson reports employment by Medialis Ltd (Banbury, UK) outside the submitted work.

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