Evaluating collaborations between primary care general practices in England

Four hands encircling image of a family, photo by Andrey Popov/Adobe Stock

Andrey Popov/Adobe Stock

Primary care networks can help GPs offer their patients more services and make changes needed in response to the COVID-19 pandemic, but additional clarification and support around the role of primary care networks in the wider NHS in England are needed.

What is the issue?

Primary care networks were introduced in 2019 by NHS England to bring together groups of general practices (GPs) to access new funding and offer extra services to improve the health and wellbeing of local communities.

The purpose of this evaluation was to look at how these networks were established, what they have achieved so far and what has helped or hindered their progress. Researchers were particularly interested in the experience of primary care networks in rural areas, and how networks fit in with other types of collaboration.

How did we help?

With our partners in the BRACE centre, we first examined previous research that had sought to understand GP collaborations over time. Researchers then chose four collaborations across England as case studies, where they carried out interviews and a survey with staff; observed meetings; and reviewed reports and papers. The findings were then analysed to develop suggested lessons for policymakers about the future development of primary care networks.

What did we find?

  • Leaders of primary care networks support the overarching policy aims of primary care networks, and GPs across England have seized the opportunity to access new funding to form networks.
  • The evaluation revealed a tension between the desire for local autonomy within primary care networks, and the top-down nature of national primary care network policy. This led to some differences between local and national priorities, and a lack of clarity around how primary care networks fit within the wider NHS.
  • The need for effective leadership and management support for primary care networks was a strong theme in the evaluation, particularly the capacity required for implementing and managing networks.
  • The relationship between clinical commissioning groups and primary care networks varied — some clinical commissioning groups supported network development; others attempted to hold on to the control delegated to primary care networks, for example through controlling budgets.
  • Some of the networks in more rural areas felt that the network policy had been developed more with urban networks in mind. For example, rural primary care has patient populations who may be unwilling or unable to travel further to a GP office they are unfamiliar with, making extended hours services less useful in rural areas.
  • In all four case studies, the primary care network was established in the context of a prior GP collaboration. These at times helped the networks build on previous successes, however there were also some tensions, such as where the aims of the two organisations did not align.

What are the lessons?

  • Primary care networks can help GPs run a wider range of services for their patients and make changes that are needed in response to the COVID-19 pandemic.
  • It will be important for additional clarification and support around the role of primary care networks in the wider NHS in England. For example, support may be needed to give primary care networks the freedom to plan for what local people need, monitor carefully the progress made, and ensure that the priorities of networks in rural areas are considered.
  • Decision makers will need to build further leadership and management capacity within primary care networks and may need to support networks in building positive relationships with clinical commissioning groups and other forms of GP collaboration.
  • A mix of quantitative and qualitative research will be needed to understand how these networks can contribute to:
    • improved sustainability;
    • efficiency;
    • integration in and beyond primary care; and
    • primary care responses to the COVID-19 pandemic.