Early Implementation of Primary Care Networks

This evaluation examined the implementation and early development of primary care networks in England, including what has helped or hindered progress, how they operate in relation to pre-existing general practice collaborations, and the specific issues faced by rural networks.

An infographic summarises the study and its key findings

Background

Primary care networks (PCNs), were introduced in the NHS in England in July 2019 with the aim of forming groups of general practices, with a shared network budget to develop new services in response to national policy intended to bring about better integration of health care within local communities.

There were (as at May 2020) 1259 primary care networks, serving populations that range from 20,000 to well above the 50,000 suggested in NHS England and Improvement primary care network-related guidance. While there is significant number of networks who serve populations that are less than the 20,000 benchmark. These primary care networks sometimes build on prior GP collaborations such as super-partnerships and federations, which provide organisational infrastructure and support to newly formed networks.  There are however some primary care networks that bring together practices that had not previously worked together in a formal collaboration.  And yet others that comprise practices from a diverse range of prior groupings.

The overarching purpose of this evaluation was to produce early evidence of the development and implementation of primary care networks, with a particular focus on why and how practices entered into primary care networks, what enabled or hindered their progress, and whether and how the experience of rural PCNs might differ from that of urban examples.

Approach

 We undertook a mixed methods cross-comparative case study evaluation with four primary care networks. The evaluation comprised four work streams:

1) A rapid assessment of published evidence to distil prior research and learning - this informed the development of questions  to be explored  in four case study primary care networks. 2)  A workshop for relevant stakeholders (e.g. academic and policy experts in primary care, patient and public involvement representatives) to determine the gaps in research evidence about GP collaborations and hence to develop evaluation questions for case study work with primary care networks.

2) Comparative case studies of four primary care networks.   We recruited four rural and urban case study sites where interviews were undertaken with those involved in the development, implementation and running of the primary care network in their respective area.  We also carried out analysis of key documentation; undertook non-participant observation of strategic meetings of the primary care networks; and conducted an online survey to collect information on challenges associated with collaborative working and measure early impact.

3) We analysed findings from work streams 1-3, synthesised these into an evaluation report which has been published by the National Institute for Health Research, and included in this a set of suggested lessons for the next stage of development of primary care networks in the NHS in England.   Other resources including slide sets, infographics, and podcasts will be available soon.

Project team

Outputs 

National Institute for Health Research, Health Services and Delivery Research stream (NIHR HS&DR) published report Early evidence of the development of primary care networks in England Professor Judith Smith, Sarah Parkinson, Dr Manni Sidhu. 
Download the full report Early evidence of the development of primary care networks in England (pdf doc)

Project Duration

September 2018 - August 2020