RESTORE
Realist evaluations of professional support and remediation
What is RESTORE?
RESTORE (Realist evaluations of professional support and remediation) is an interdisciplinary research programme that aims to optimise the delivery of professional support (including remediation) for health professionals, across specialties and career stages, and make informed recommendations to improve practice.
The RESTORE programme of research comprises five projects, details on which are provided below.
RESTORE 1
Funding amount: £185,107.26
Location: University of Plymouth
Dates: April 2018 – January 2020
University of Plymouth PI:
Professor Nicola Brennan
University of Plymouth staff:
Professor Tom Gale ,
Dr Tristan Price ,
Dr Lyndsey Withers ,
Dr Marie Bryce , Ms Amanda Wanner
Project partners: Dr Geoff Wong, University of Oxford; Dr Linda Prescott-Clements, Royal College of Veterinary Surgeons; Professor Julian Archer, Monash University, Australia; Professor Jennifer Cleland, Nanyang Technological University, Singapore
Overview
The human cost of a failing doctor is difficult to measure, but it is estimated that nearly 12,000 patients die in England each year as a result of preventable medical errors. All of us, as patients, expect our doctors to be competent. If they are not, we expect the doctors to be stopped from practising.
The General Medical Council has powers to do this. However, there is a wider problem that is more difficult to address: doctors who underperform. For this group of doctors, they do not need to stop practising but, to keep patients safe, they need help. This could be through retraining in a certain area, or perhaps addressing underlying physical or mental health problems. Bringing a doctor’s performance back up to an acceptable standard is called remediation.
Objectives
- To conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent do remediation programmes for practising doctors work to restore patient safety.
- To provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.
Publications
Price T, Brennan N, Wong G, Withers L, Cleland J, Wanner A, Gale T, Prescott-Clements L, Archer J & Bryce M (2021), 'Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review', Health Services and Delivery Research 9, (11) 1-116, https://doi.org/10.3310/hsdr09110
Price T, Wong G, Withers L, Wanner A, Cleland J, Gale T, Prescott-Clements L, Archer J, Bryce M & Brennan N (2021), 'Optimising the delivery of remediation programmes for doctors: A realist review', Medical Education, 55 (9). https://doi.org/10.1111/medu.14528
Price T, Brennan N, Cleland J, Prescott-Clements L, Wanner A, Withers L, Wong G & Archer J (2018), 'Remediating doctors' performance to restore patient safety: a realist review protocol', BMJ Open 8, (10) e025943-e025943, 1-7. https://doi.org/10.1136/bmjopen-2018-025943
RESTORE 2
Funding amount: £742,620.24
Location: University of Plymouth
Dates: July 2021 – June 2025
University of Plymouth PI:
Professor Nicola Brennan
University of Plymouth staff:
Dr Ellie Reynolds ,
Dr Tristan Price ,
Professor Tom Gale ,
Professor Helen Lloyd ,
Dr Lyndsey Withers
Project partners: Dr Geoff Wong, University of Oxford; Professor Jennifer Cleland, Nanyang Technological University, Singapore
Overview
The optimal performance of doctors is essential to the provision of high-quality and safe care for patients. Professional support services exist to provide help, guidance and access to additional training and support for doctors in difficulty, to remedy problems and to help with career development.
Our realist review of the literature (RESTORE 1) found that remediation interventions work when they develop doctors' insight and motivation, and reinforce behaviour change. However, our review also identified significant knowledge gaps. Most studies were from North America; few focused on the UK NHS setting. There was also a lack of detailed high-quality data to effectively test the programme theory and, in particular, the potential contextual impacts on intervention effectiveness.
Objectives
- To use a participatory co-design approach to help NHS organisations incorporate evidence-based recommendations to optimise the delivery of existing professional support interventions for doctors
- To use a realist approach to evaluate how NHS professional support programmes produce their effects
- To develop:
- NHS-specific 'recommendations' for the optimisation of professional support programmes
- an 'implementation toolkit' for professional support programme leads in the NHS that helps them to improve their professional support programmes based on the NHS-specific 'recommendations'.
Publications
Brennan N, Reynolds E, Price T, et al. (2026) Optimising professional support for doctors who experience work performance issues: a realist evaluation,
BMJ Quality & Safety 35: 517-526. http://doi.org/10.1136/bmjqs-2025-019749
BMJ Quality & Safety 35: 517-526. http://doi.org/10.1136/bmjqs-2025-019749
Reynolds E, Lloyd H, Cleland J, Wong G, Withers L, Price T, Gale T, Brennan N (2025), 'Implementing recommendations to optimise professional support in the medical workplace: A participatory co-design approach', Medical Education, 1–12. https://doi.org/10.1111/medu.70054
Brennan N (2021), 'Emotions, psychological safety and recommendations for designing remediation programmes', Medical Education, 56 (2) 141-143.
Brennan N, Reynolds E, Price T, Wong G, Withers L, Cleland J, Lloyd H, Gale T (2025),
A Guide to Optimise the Delivery of Professional Support in the NHS . University of Plymouth, Plymouth.
RESTORE 3
Long title: The remediation of professionalism in undergraduate medical students: a realist evaluation
Funded by:
Peninsula Medical School Studentship
Location: University of Plymouth
Dates: April 2024 – March 2028
PhD candidate:
Ross Raymond-Jones
Director of studies:
Dr Tristan Price
Objective
To identify how, why, for whom, in what context and to what extent professionalism remediation interventions work for undergraduate medical students
Publications
Raymond Jones R, Brennan N, Bryce M, Gale T, Price T (2026) A realist review of the remediation of professionalism lapses in undergraduate medical students (RESTORE 3) Medical Teacher, 1–16. https://doi.org/10.1080/0142159X.2026.2718311
RESTORE 4
Long title: Professional support services for dentists: a modified realist approach
Funded by:
Faculty of Health Studentship
Location: University of Plymouth
Dates: October 2025 – September 2029
PhD candidate:
Aya Al-Harbawee
Director of studies:
Dr Marie Bryce
Objective
To identify why, how, for whom and to what extent professional support programmes work to enable dentists in difficulty to continue to practise safely.
RESTORE 5
Long title: Tailoring professional support services for psychiatrists: A realist evaluation
Funded by: NIHR ARC South West Peninsula (PenARC)
Location: University of Plymouth
Dates: October 2026 – September 2029
PhD Candidate:
Laura Naylor
Director of Studies:
Professor Nicola Brennan
Objective
To identify why, how, in what contexts, for whom and to what extent professional support programmes for psychiatrists produce their effects.
University of Plymouth researchers
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![Professor Nicola Brennan Professor of Medical Education and Workforce Research]( "Professor Nicola Brennan")
Professor Nicola Brennan
Professor of Medical Education and Workforce Research
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![Dr Ellie Reynolds Research Fellow]( "Dr Ellie Reynolds")
Dr Ellie Reynolds
Research Fellow
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![Dr Tristan Price Associate Professor of Clinical Education]( "Dr Tristan Price")
Dr Tristan Price
Associate Professor of Clinical Education
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![Professor Tom Gale Associate Head of School (Research)]( "Professor Tom Gale")
Professor Tom Gale
Associate Head of School (Research)
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![Professor Helen Lloyd Associate Head of School for Internationalisation]( "Professor Helen Lloyd")
Professor Helen Lloyd
Associate Head of School for Internationalisation
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![Dr Lyndsey Withers Visiting Specialist]( "Dr Lyndsey Withers")
Dr Lyndsey Withers
Visiting Specialist
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![Dr Marie Bryce Senior Research Fellow (CAMERA)]( "Dr Marie Bryce")
Dr Marie Bryce
Senior Research Fellow (CAMERA)
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![Professor Sally Hanks Professor of Primary Care Dentistry]( "Professor Sally Hanks")
Professor Sally Hanks
Professor of Primary Care Dentistry
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![Dr Ian Mills Honorary Associate Professor]( "Dr Ian Mills")
Dr Ian Mills
Honorary Associate Professor
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![Mr Ross Raymond-Jones Lecturer in Clinical Education (Physician Associate Studies)]( "Mr Ross Raymond-Jones")
Mr Ross Raymond-Jones
Lecturer in Clinical Education (Physician Associate Studies)
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![Aya Al-Harbawee]( "Aya Al-Harbawee")
Aya Al-Harbawee
University of Oxford
University of Aberdeen
Nanyang Technological University Singapore
National Institute for Health and Care Research
Department of Health and Social Care disclaimer
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Contact Dr Nicola Brennan
CAMERA, University of Plymouth, C521, Portland Square, Drake Circus, Plymouth, Devon, PL4 8AA
Centre for Applied Medical, Health and Care Education and Workforce Research (CAMERa)
CAMERa exists to strengthen the capability and sustainability of the health and care workforce through high-quality, applied research.
Our vision is to be a world-leading research centre that transforms health and care through applied research that strengthens workforce capability, shapes policy and practice, and creates lasting improvements in Plymouth, our region and around the world.
