opportunities to couple proposals and problems. There were a number of examples of the group seizing op- portunities to make incremental progress on individual elements of their plan such as requesting funding for diabetes nurse specialist posts which have now been funded as part of the National Clinical Care Programme and efforts involving members of the EAG to introduce a national clinical lead for diabetes in Ireland. Policy en- trepreneurs are often driven by desire for change and the opportunity for implementation, referred to by a number of our participants as the main reason for joining the EAG. Exworthy et al. [47] advise that local expecta- tions are often dashed by the central policy approach and vice versa, hence there is a need to align top-down and bottom-up expectations regarding implementation. In this study, there were unmet expectations regarding im- plementation and the group’s role in that process. There is a risk of policy fatigue or burnout among stakeholders who regularly engage in policy formulation but see little return on their investment in terms of demonstrable change.