Implementation Champions and Leadership

Training was not delivered at all in two of four sites, and attendance at training did not guarantee that participants subsequently delivered the pathway. GP engagement was a critical prerequisite for implementation, with practice-level adoption described as essentially impossible without an enthusiastic GP. Consistent involvement of senior clinical figures was particularly valuable for bridging hierarchical structures, building cross-team connections, and advocating for resource release. The initial pace of implementation uptake was driven more by the skill and dedication of implementation leads and champions than by the design quality of the pathway or training attendance. The reach of individual champions was geographically and socially limited, making sole reliance on champions an unstable, patchy implementation approach.