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Exploring the scope for Normalisation Process Theory to help evaluate and understand the processes involved when scaling up integrated models of care: a case study of the scaling up of the Gnosall memory service

Michael Clark (Care Policy and Evaluation Centre, Lodond School of Economics and Political Science, London, UK )
David Jolley (Personal Social Services Research Unit, University of Manchester, Manchester, UK)
Susan Mary Benbow (University of Chester, Chester, UK)
Nicola Greaves (Gnosall Practice, Gnosall, UK)
Ian Greaves (Gnosall Practice, Gnosall, UK)

Journal of Integrated Care

ISSN: 1476-9018

Article publication date: 26 August 2020

Issue publication date: 5 February 2021




The scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a (pilot) locality can often leave us some way from understanding how the innovation worked and what was crucial about the context to achieve the goals evidenced when applied to other localities. Even unpacking the “black box” of the innovation can still leave gaps in understanding with regard to scaling it up. Theory-led approaches are increasingly proposed as a means of helping to address this knowledge gap in understanding implementation. Our particular interest here is exploring the potential use of theory to help with understanding scaling up integration models across sites. The theory under consideration is Normalisation Process Theory (NPT).


The article draws on a natural experiment providing a range of data from two sites working to scale up a well-thought-of, innovative integrated, primary care-based dementia service to other primary care sites. This provided an opportunity to use NPT as a means of framing understanding to explore what the theory adds to considering issues contributing to the success or failure of such a scaling up project.


NPT offers a framework to potentially develop greater consistency in understanding the roll out of models of integrated care. The knowledge gained here and through further application of NPT could be applied to inform evaluation and planning of scaling-up programmes in the future.

Research limitations/implications

The research was limited in the data collected from the case study; nevertheless, in the context of an exploration of the use of the theory, the observations provided a practical context in which to begin to examine the usefulness of NPT prior to embarking on its use in more expensive, larger-scale studies.

Practical implications

NPT provides a promising framework to better understand the detail of integrated service models from the point of view of what may contribute to their successful scaling up.

Social implications

NPT potentially provides a helpful framework to understand and manage efforts to have new integrated service models more widely adopted in practice and to help ensure that models which are effective in the small scale develop effectively when scaled up.


This paper examines the use of NPT as a theory to guide understanding of scaling up promising innovative integration service models.



Michael has provided independent input in to the work reported here. David, Susan, Nicola and Ian have been involved in establishing the Gnosall dementia service discussed in the paper and offered and provided some support to the roll out discussed, but were not closely involved in or responsible for this programme. We are very grateful to those who helped us understand the roll out, though the views expressed here are entirely those of the authors.


Clark, M., Jolley, D., Benbow, S.M., Greaves, N. and Greaves, I. (2021), "Exploring the scope for Normalisation Process Theory to help evaluate and understand the processes involved when scaling up integrated models of care: a case study of the scaling up of the Gnosall memory service", Journal of Integrated Care, Vol. 29 No. 1, pp. 3-21.



Emerald Publishing Limited

Copyright © 2020, Emerald Publishing Limited

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