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
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.
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.
- National Institute for Health and Care Research, Health Services and Delivery Research stream (NIHR HSDR) published report Early evidence of the development of primary care networks in England: a rapid evaluation study Professor Judith Smith, Sarah Parkinson, Dr Manni Sidhu; September 2022
- BMJ Open article January 2022: Sarah Parkinson, Judith Smith and Manni Sidhu Early development of primary care networks in the NHS in England: a qualitative mixed-methods evaluation
- Health Foundation Long Read, 28 January 2021: Manni Sidhu and Judith Smith along with colleagues from RAND and the Health Foundation NHS reforms : Five key questions about the future of primary care networks in England
- British Medical Journal article 24 November 2020, Adrian O'Dowd Primary Care Networks: More effort is needed to engage with General Practices, says report
- Blog by Manni Sidhu: GP Online 16 November 2020 Can PCNs overcome the challenges facing rural primary care
- GP Online article 16 November 2020, Luke Haynes Rural Practices Struggling to deliver 'urban-focused' PCN targets, NIHR report warns
- Blog by Sarah Parkinson: BJGP Life 11 November 2020 Primary care networks in a time of pandemic
- Health Service Journal exclusive coverage 10 November 2020, Jasmine Rapson Confusion and tensions over PCNs despite their 'early operational success'
- Blog by Judith Smith: HSJ 10 November 2020 Primary care networks: getting into their stride?
- Professor Judith Smith. Primary care networks in the English NHS: (another) triumph of hope over experience. HSR UK 2020 Conference.
- Comment by Judith Smith and Amelia Harshfield : HSJ 10 September 2019 : Primary Care Networks: A marathon not a sprint
- Amelia Harshfield, Natasha Elmore, Jon Sussex. The evaluation of large-scale collaborations between primary care general practices. PROSPERO 2018 CRD42018110790
September 2018 - August 2020