Table 2 Meso level of context: Institutional, network relations, relationships and interaction history prior to implementing intervention

History of interactions prior to implementation

Practice staff trained on study protocol and procedures as well as specific guidance on how to manage telephone triage appointments during trial;

Receptionists received specific guidance with script on how to introduce triage to patients; nurses received training to use computer-decision support software;

Research team liaised with practice staff throughout set up and delivery of trial. Individualised procedures were provided to all staff.

Institutional and network relations

Prior to ESTEEM, patients telephoned or visited surgery to book a same-day GP appointment. Following introduction of intervention, patients’ expectations of accessing care briefly re-oriented to telephone triage by receptionist.

Local policy on patient management

Practice specific procedures on managing telephone triage – e.g. triage sessions, staff allocation – nurse practitioners, practice nurses