The elevate study – identifying innovative models of urgent care in rural coastal areas in England: A mixed methods study protocol

Introduction Urgent and emergency care (UEC) systems in England face unprecedented pressures, with record A&E attendances, persistent breaches of ambulance response targets, and poorer outcomes for time-sensitive conditions. National UEC recovery plans have introduced multiple innovations—such as Same Day Emergency Care, virtual wards, and specialty hubs— to expand capacity and improve patient flow. Rural coastal areas are particularly vulnerable to excessive demand due to higher levels of deprivation, older populations with complex health needs, seasonal surges that generate unpredictable demand, and challenges in attracting and retaining staff. Following the Chief Medical Officer’s 2021 Annual Report, funding research and developing bespoke solutions to manage UEC demand and address geographical disparities has been recognised as a national priority. The Elevate Study responds to this priority by identifying and evaluating innovative models of UEC in rural coastal communities in England.

Methods and analysis The Elevate study is a 30-month, mixed-methods evaluation that comprises three interlinked work packages:

1. National service mapping – Outlining provision of innovative models of UEC in rural coastal areas of England. This will be developed through document review and interviews with regional and national service leaders.

2. Quantitative analysis – Quasi-experimental and longitudinal approaches will use NHS England’s Emergency Care Data Set and linked routine NHS datasets to evaluate the impact of UEC models on health and process outcomes. Standard and bespoke metrics will be developed and used to assess performance.

3. Qualitative case studies – Up to 12 case studies of UEC models in rural coastal communities. Interviews with patients and staff and non-participant observation will explore how and why different UEC models influence patient experience, clinical outcomes, resource use, and the workforce.

Findings will be integrated using the Consolidated Framework for Implementation Research (CFIR) to identify components of UEC models that are effective, scalable, and sensitive to local context.

Ethics and dissemination

Ethical approval for qualitative components was granted by the North of Scotland Research Ethics Committee (25/NS/0099). Dissemination will include peer-reviewed publications, policy briefs, creative media, and community engagement activities to ensure findings are communicated inclusively and effectively to policymakers, health and social care practitioners and the public.

Strengths and limitations

· This study will provide evidence to ensure future national UEC directives are informed by solutions that are designed to address local needs and reduce geographical inequalities.

· The mixed-methods design will provide a comprehensive assessment of which innovative models of care are likely to be most effective at reducing UEC demand in rural coastal areas to maximise performance, reduce workforce pressures and improve patient outcomes.

· Reliance on external, routine datasets may limit completeness and timeliness of quantitative analysis.

· Heterogeneity of local adaptations poses challenges for scalable policy change/development and comparative evaluation.