Primary Care Networks

The aim of this study is to understand the processes by which primary care services are commissioned and contracted for at neighbourhood level, and to explore the impact and outcomes of those processes. We will look specifically at the new system and the operation and outcomes of network collaborative working.

The Long Term Plan, new GP contract, and NHS Operational Planning and Contracting Guidance 2019/20 set out a direction of travel for local service commissioning and provision which suggests primary care services will be increasingly delivered by collaborating networks of practices operating at a ‘neighbourhood’ level, usually defined as populations of 30-50,000. Whilst GP practices have collaborated together for a variety of purposes for many years, the new contract proposals envisage a closer working relationship including: shared employment of staff; network-level contracts, payments and incentives; and collaboration over back-office functions. It is argued that these developments will support the integration of services between primary, community, secondary and social care, and ensure the future sustainability of primary care services whilst improving the quality of services. The timetable for these changes is short, with practices required to organise themselves into networks by June 2019.

These changes a centre-piece of the NHS Long Term Plan, the recent changes to the GMS contract and the recently published NHS Planning Guidance. The way in which networks develop is therefore of vital importance if the ambitions of the Long Term Plan are to be realised. Understanding in more depth the objectives of the policy and factors affecting implementation will provide important evidence to underpin NHS England policies and guidance and DHSC policy oversight. Thus, it is important that research is undertaken to inform and support DHSC and NHS England as they roll out the new contractual processes and support systems required.

• To understand the objectives underlying the current changes to primary care commissioning and contracting, and to explore the intended outcomes
• To explore the formation and operation of networks, including their impact on constituent practices and their accommodation alongside existing collaborative ventures
• To investigate the implementation of the contractual changes at local level, including
  mechanisms for support, monitoring, payment and contract management and to understand the factors affecting this
• To explore the mechanisms by which practices are working together across geographical neighbourhoods, including approaches to staff payment, recruitment and management, and the operation of network-level incentives
• To understand how networks of practices are engaging with other local service planning and provision, both at neighbourhood level (including community and voluntary sector service provision) and at the level of Integrated Care Systems (ICS) and Sustainability and Transformation Partnerships (STP)
• To identify outcomes associated with the new arrangements, including staff and patient satisfaction, impacts on quality of care and effects on integration with other services

The initial stages of the project included: interviews with policy makers to explore their objectives for PCNs; quantitative analysis of the size and shape of PCNs on the ground, including their make up and disease burden; and telephone interviews with CCG leads responsible for supporting PCNs as they develop. We show that there are multiple policy objectives espoused for PCNs, and that these may not be mutually compatible, at least in the short term. We also show that PCNs are highly variable in their size and constitution, and as such will face differing challenges. Finally we highlight how important CCG support and managerial expertise has been in the early stages of PCN development. We consider the implications of these for ongoing policy development as PCNs respond to current challenges.