The early implementation of primary care networks in the NHS in England: a rapid evaluation study

Research output: Book/ReportCommissioned report

Authors

Colleges, School and Institutes

External organisations

  • RAND Europe

Abstract

Background: Primary care networks (PCNs) are groups of general practices brought together in July 2019 to hold shared budgets and develop new services in response to NHS England/Improvement policy for better integration of health care. Evidence was sought about early implementation of PCNs, especially what has helped or hindered progress, how they operate in relation to pre-existing collaborations in general practice, and issues for rural as compared with urban PCNs.

Objective: To produce early evidence of the development of PCNs to inform subsequent policy and support to be provided to these new collaborations. Our research questions were designed to investigate 1) the contextual policy background of primary care networks; 2) the rationale and motives for general practices to enter into GP collaborations; 3) the facilitators and challenges of establishing GP collaborations and newly formed primary care networks; 4) barriers to and facilitators of effective collaboration across GP practices; and, 5) the likely progress of primary care networks in the NHS in England, including in light of the Covid-19 pandemic and associated challenges.

Design: A qualitative cross-comparative case study evaluation comprised of four work packages:
1) A rapid evidence assessment (REA);
2) A workshop with academics, policy experts, and patient/public representatives;
3) Interviews with stakeholders across four case study sites, alongside observations of meetings, an online survey, analysis of documents; and
4) Analysis of findings from work packages 1-3 to develop recommendations for the next stage of development of primary care networks.

Results: Primary care networks have been implemented using a range of approaches to collaborative working in general practice across rural and urban settings. Previous GP collaborations provide much-needed support in terms of management, leadership and infrastructure, although they can be a source of tension within primary care networks where interests, goals and ways of working of the prior collaboration and primary care network do not align.
Reasons for collaborative working in primary care networks typically focus on the sustainability of primary care and better integrated care for patients, although reasons cited for joining the networks were mostly related to policy and financial incentives. Early evidence reveals operational success by primary care networks in establishing organisational structures, recruiting to new roles, and providing services as required by the national primary care network specification.
Effective management and leadership, particularly with respect to having a committed Clinical Director able to take on the role for the medium to longer term, and constructive relationships between the primary care network and clinical commissioning groups (CCGs) are important in ensuring the success of networks. In rural areas, there was some perceived lack of fit with aspects of the primary care network specification, alongside existing challenges of providing primary care to rural populations.

Limitations: Gaining access, arranging and completing interviews proved difficult in all case study sites as result of general practices mobilising and preparing for the implementation of primary care network policy (July 2019). Following onset of the Covid-19 pandemic, the team was unable to undertake planned site-specific and face- to-face workshops to explore findings with policy experts. Given the evolution of primary care networks was in its infancy (less than nine months) at the time of this evaluation, drawing broad substantive conclusions at this stage remained difficult.

Conclusions: Key lessons focus on:
• Increasing the engagement of GP practices and wider primary care teams with primary care networks’PCNs aims, work programmes, and future development.
• Building leadership and management capacity to support primary care networks in fulfilling their contractual obligations and meeting local health needs.
• Clarifying how primary care networksPCNs will operate in the post-Covid-19 wider health and social care system, including the role they will play in coordinating, supporting and extending primary care service provision.

Future work: Evaluating the impact and effectiveness of primary care networks using a careful mix of quantitative and qualitative measures, focused on known gaps in evidence about GP collaborations; undertaking such researchPCNs in both rural and urban areas and exploring the extent to which this context is significant or not; the role, cost and effectiveness of leadership and management support within primary care networks including how this can be sustained and extended, and understanding the relationships between primary care networks PCNs and the wider health and care system and what this means for their future role.


Details

Original languageEnglish
PublisherNational Institute for Health Research
Commissioning bodyNIHR HS&DR Programme
Number of pages205
Publication statusAccepted/In press - 2020

Keywords

  • pPrimary care; general practice; pPrimary care organisation; primary care network; general practitioner collaboration; rapid evaluation; qualitative research; rural primary care