Early development of primary care networks in the NHS in England: a qualitative mixed-methods evaluation

Abstract

ObjectivesPrimary care networks (PCNs) were introduced in the National Health Service (NHS) in England in 2019 to improve integrated care for patients and help address financial and workforce sustainability issues in general practice. The purpose of this study was to collect early evidence on their implementation and development, including motivations to participate and what enables or inhibits progress. This paper considers the core characteristics of PCNs, and how this informs their management.DesignA qualitative mixed-methods rapid evaluation was conducted across four case study sites in England, informed by a literature review and stakeholder workshop. Data collection comprised interviews, non-participant observation of meetings, an online survey and documentary review.ResultsGeneral practitioners (GPs) are motivated to participate in PCNs for their potential to improve patient care, enable better coordinated services and enhance financial and workforce sustainability within primary care. However, PCNs also have an almost mandatory feel, based on the national policy context and significant financial incentives associated with joining them. PCNs offer potential to bring GPs together to work towards common goals, deliver national priorities and respond rapidly to local needs.ConclusionsPCNs face similar challenges to other meso-level primary care organisations internationally, as they respond to local and national priorities and operate in a context of multiple goals and interests. In managing these organisations, it is important to find a balance between local and national autonomy, decision making and control.

Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads

“…A key consideration in efforts at transforming primary care in Scotland is the balance between bottom-up and top-down approaches, something that has also been highlighted in early evaluation research into the development of PCNs in England [37]. Although joint guidance was published in June 2019 by the SG, the Scottish General Practice Committee of the British Medical Association, and the Royal College of General Practice, which included issues such as the need for adequate administrative support, its appears that this guidance has not been implemented in any meaningful way [38].…”

Financing networks of care: a cross-case analysis from six countries

“…Table 2 shows information about NOC in each country 27–46. Most cases are networks implemented as a national strategy, except for Canada that—in line with the organisation of the country’s health system—presents the experience of one province (Alberta) and the USA with a national-level programme that is designed for supporting specific regions (rural areas).…”

“…Table 3 presents the analysis of NOC’s financial arrangements for all the analysed cases 27–46. First, it is noted that the financing source for the NOC in all countries is the government, mostly through resources coming from the Ministry of Health.…”

Vertical integration of GP practices with acute hospitals in England and Wales: rapid evaluation

“…Finally, there was significant cross-learning with another BRACE project 75 that is specifically exploring the early implementation of PCN working across England. This cross-learning supported nuanced interpretation of how vertical integration was being implemented in tandem with wholesale primary care policy changes involving horizontal integration.…”