National Centre for Remote and Rural Health and Care: evaluation

Chapter 4: Research and Evaluation

Research and Evaluation underpin the Centre’s ambition to create an evidence-driven approach to rural health and care. Historically, rural services have lacked robust data and systematic evaluation, limiting innovation and policy development. This pillar focuses on practitioner-led research, embedding evaluation in programme design and fostering knowledge exchange. The following section assesses progress to date and explores how these efforts are shaping the rural evidence base.

Inaugural Phase Targets

The National Centre’s Inaugural Phase Targets for work under the Research and Evaluation pillar, and their progress to date, are as follows.

Targets achieved

• Design and delivery of new set of funded R&R academic clinician study programmes for PhD, MSc, Fellowships for up to 10 R&R practitioners
  • The National Centre has supported 27 practitioners for the Rural Advanced Practice (RAP) MSc.
  • Five rural GP fellows have been supported by the National Centre in completing their rural fellowship projects.
• Structure established, and applications opened for new funded R&R Primary Care workforce professional development study/award for up to 15 practitioners
  • This rural-specific awards programme supported 14 practitioners to undertake small-scale research, evaluation, and improvement projects.

Targets progressed

• Structure established, and applications opened for R&R Primary Care Workforce Publications Funding for 4 practitioners
  • Rural Practitioner Publishing Award has been established.
  • As of March 2025, no applications had been received.
• Evaluation completed and reported for 2 practical multidisciplinary R&R primary care service-led projects
  • Evaluation plans and programme theory for the RAP MSc Programme were complete as of September 2025, with ongoing alignment to routinely collected data.
  • Evaluation plans for the Scottish Ambulance Service (SAS) MSc Pilot were complete as of September 2025.
  • Evaluation plans for Rural GP Dispensing Practices Training Development were complete as of September 2025; evaluation will be embedded in the e-learning package and is scheduled to complete in March 2026.
  • Substantial evaluation development completed for the Community Training Hub as of June 2025, including framework and tools; baseline data collection underway.
  • Evaluation of Local Implementation of the Making it Work Framework in Skye completed as of September 2025, including report and recommendations.
• Evaluation completed for 2 practical R&R-specific RCGP linked projects
  • Project 1: Rapid review of rural GP priorities completed (workload, retention, long-term solutions).
  • Project 2: Final report on rural GP survey completed; RGPAS conference data to be written up by end of March 2026.
• Action plan established and implemented for an international comparative research programme
  • International comparative research projects are ongoing, including crosswalk policy analysis comparing rural placement models in Scotland, Australia, New Zealand, and the USA

The National Centre has made strong progress in establishing research and evaluation capacity during its inaugural phase. Two major targets have been achieved:

• Academic study programmes: 27 practitioners have been supported through the MSc Rural Advanced Practice programme, and five rural GP fellows have completed fellowship projects.
• Professional development awards: A rural-specific awards scheme enabled 14 practitioners to undertake small-scale research and improvement projects.

Other areas show partial progress. The Rural Practitioner Publishing Award has been launched, but no applications were received by March 2025 (the most recent date data was held for), suggesting a need for greater promotion and support. Evaluation activity is advancing but remains incomplete. Plans and frameworks have been developed for several initiatives, including the Rural Advanced Practice (RAP) MSc, Scottish Ambulance Service (SAS) MSc pilot, dispensing practice training, and the Community Training Hub, but most evaluations are scheduled for completion in 2026. One evaluation, on the implementation of the Making it Work framework in Skye, has been completed and reported.

Work on international comparative research is underway, including a cross-country analysis of rural placement models in Scotland, Australia, New Zealand and the USA. However, progress against targets for RCGP-linked projects is unclear, and outputs have not yet been reported.

Overall, the Research and Evaluation pillar has delivered foundational structures and early outputs, but measurable impacts and published findings are still emerging. Future priorities include accelerating evaluation completion, increasing uptake of publication funding, and ensuring learning from international comparisons informs policy and practice.

Summary of National Centre Activities

Throughout the inaugural phase of its work, The National Centre has made research and evaluation one of its priorities to increase the remote and rural evidence base, improving healthcare delivery in remote and rural communities. Some of its work in this area includes:

• Collaborative community-based participatory research: Work such as ‘Rural Health Past, Present and Future’ with the University of Highlands and Islands.
• Collaborative research into rural health inequalities: Work with Public Health Scotland to improve health equity and service delivery, ‘Remote and Rural Scottish Population Health Data Project’.
• Building a Research and Evaluation Network with over 175 members.
• Creating and awarding 14 development funding awards for rural practitioners in research and evaluation, increasing research capacity and supporting professional development, such as the point of care ultrasound training described in Chapter 3. Additional awards include funding towards practitioners' degrees such as an MSc in Healthcare Management for a music therapist in Ayrshire and Arran and a PhD in Orthodontic Sustainability for an orthodontist from Shetland, as well as projects including a Highland GP’s Health Data App pilot and a redesign of diabetic care in the Western Isles.
• Progressing evaluation of The National Centre’s Education and Training projects, such as the Rural Advanced Practice (RAP) MSc.
• Progressing evaluation of The National Centre’s Recruitment and Retention projects to assess their success in sustaining a skilled workforce, such as the Making it Work Framework.

Reflections

The evaluation considered what evidence has been produced and by whom, who has accessed it, and how it is shared, used and influencing practice.

Participation

About one in three (29%, n=71) survey respondents were involved in research or publication opportunities supported by or facilitated by the National Centre, and an equivalent proportion (29%) were involved in evaluation involving rural or remote services (Figure 4.1). Respondents also cited being involved in academic study programmes, service-led project evaluations and international comparative research with rural relevance.

Of those who responded to the survey and said they had been involved in research and evaluation activities (n=38), the majority were healthcare professionals including GPs, allied health professionals and advanced nurse practitioners. Others included National Centre staff and third sector stakeholders.

Benefits

The primary benefits mentioned by participants in research and evaluation activities supported by The National Centre included the opportunity to contribute to changes in rural practice or service delivery, increased confidence in engaging in rural research and evaluation, as well as improved research skills, work visibility and interest in rural research.

One participant who took part in the RAP MSc shared how much they appreciated the support they had from the National Centre to conduct their own research and get their work published, as these were opportunities they otherwise would not have pursued.

“Things like presenting poster presentations for conferences, writing a research paper and getting it published…that was not something I'd ever thought about doing.”

Shared learning

Those who took part in rural research and evaluation were also asked how their work had led to shared learning. Participants mentioned the National Centre supporting them in sharing their findings at conferences such as the Royal College of Nursing Education Forum and the NES Annual conference, through journal publications, as well as via internal presentations and briefings.

By promoting shared learning across its research and evaluation activities, the National Centre has communicated these findings to a wider audience. As a result, colleagues in remote and rural areas have made stronger connections and have increased dialogue:

“These activities have supported colleagues in applying evidence-based approaches in their own contexts and fostered cross-sector dialogue about effective models of care in rural settings.”

Additionally, some shared that urban colleagues now have a greater understanding of the unique challenges in remote and rural areas:

“[Shared learning has led to] better awareness amongst urban colleagues of the remote-rural reality and its bespoke burdens.”

Embedding evaluation

One significant element of research and evaluation for the National Centre is ensuring it’s embedded in all of the National Centre’s activities. Stakeholders underscored the importance of this facet of the National Centre’s work in relation to its other ongoing workstreams as well as its broader goals and mission.

“Evaluation kind of is a foundation under all of [the pillars] …It really is a silo that can inform the entire mandate of the National Centre but also should be informing through its findings and through its reports, Scottish Government policy as well.”

Moreover, some National Centre staff also shared this view and explained that over the course of their time working at the National Centre, the organisation has adopted this perspective and is planning evaluation early on in each project’s development.

“In terms of thinking about evaluation of any piece of work, we're working on any project to try and show impact. What changes, what improvements have [resulted from] projects that we're working on. I think research and evaluation is being embedded more and more.”

The quarterly highlight report and workplan from September 2025 evidenced this, with project updates including information regarding future plans for evaluation.

Barriers

Although participants commended the work being done in research and evaluation for its contributions to a stronger rural evidence base and knowledge sharing efforts, many also cited barriers or challenges they faced when engaging with or delivering rural research and evaluation work.

The most cited barriers were lack of time or flexibility, limited access to funding and the lack of existing remote and rural evidence base. More specifically, healthcare professionals shared that finding the time to work on their research projects was one of the biggest challenges they faced

“Trying to combine it with full time clinical work…Finding time.”

Non-healthcare professionals also understood time to be a big barrier for clinicians who are interested in undertaking research:

“I think there are [healthcare professionals] just trying to keep their head above water and provide as best a service as they can and they haven't got time in the programme to do some research.”

Another suggested that one of the challenges they find with research and evaluation is ensuring the findings inform policy and change after the work is completed.

“It's always the challenge with the research and evaluation whether it's at the National Centre or elsewhere, how do they feed the findings back into policy.”

Looking Ahead

Stakeholders identified a few priorities for the next phase of the National Centre’s work in research and evaluation. These included:

• Increased support for clinicians to undertake research, such as freeing up their time or pairing them with a research assistant or team to handle some of the associated research tasks.
• Improving the visibility of the National Centre’s research outputs, such as through a public facing website.
• Continuing to move towards more interconnected working where research and evaluation underpin all of the National Centre’s work.

Assessment of progress

The Research and Evaluation pillar has laid important groundwork for strengthening the remote and rural evidence base and supporting professional development, while delivering some notable achievements. Two headline targets have been met: the design and delivery of academic study programmes and the establishment of professional development awards. Through these initiatives, the National Centre has supported 27 practitioners to complete the RAP MSc programme and funded five rural GP fellows to undertake fellowship projects. In addition, 14 practitioners have received rural-specific development awards to carry out small-scale research and improvement projects, helping to build research capacity within the workforce.

Progress on other targets has been more mixed. The Rural Practitioner Publishing Award was launched, but uptake has been low, with no applications received by March 2025. This suggests that while the structure is in place, further promotion and practical support will be needed to encourage clinicians to engage in publication activity. Evaluation work is advancing but remains incomplete.

Frameworks and plans have been developed for several initiatives, including the RAP MSc, SAS MSc pilot, dispensing practice training, and the Community Training Hub, but most evaluations are scheduled for completion in 2026. One evaluation, on the implementation of the Making it Work framework in Skye, has been completed and reported, providing early insights into service redesign in rural contexts. International comparative research is underway, including a cross-country analysis of rural placement models in Scotland, Australia, New Zealand and the USA, but outputs have not yet been disseminated. Similarly, progress against targets for RCGP-linked projects remains unclear.

Survey evidence indicates that around one-third of respondents have engaged in research or evaluation activities supported by the National Centre. Participants reported benefits such as increased confidence in undertaking research, improved skills, and opportunities to influence rural service delivery. Shared learning has occurred through conference presentations, journal publications, and internal briefings, fostering dialogue across sectors and raising awareness of rural challenges among urban colleagues. Stakeholders also highlighted the growing integration of evaluation into project design, with evidence that planning for impact is becoming embedded across workstreams.

Despite these positive developments, barriers persist. Time constraints, limited funding and the absence of a strong pre-existing rural evidence base were the most frequently cited challenges. Clinicians in particular reported difficulty balancing research with full-time clinical responsibilities. Stakeholders also noted the need for clearer mechanisms to ensure research findings feed into policy decisions, reinforcing the importance of visibility and dissemination.

Looking ahead, priorities include increasing support for clinicians to undertake research, improving the visibility of outputs through public-facing platforms and embedding evaluation more systematically across all pillars of the National Centre’s work.

In summary, the inaugural phase has established a strong platform for rural research and evaluation, delivering key capacity-building initiatives and early outputs. However, measurable impacts and published findings are still emerging. Addressing barriers to participation and strengthening dissemination will be critical to ensure that research and evaluation activities influence policy and practice and deliver sustained benefits for remote and rural communities.