New research on Primary Care Networks reports significant progress, and challenges ahead

Primary care networks need to increase the engagement of GP practices and wider primary care teams, and strengthen their leadership and management, to become firmly established to meet the challenges ahead, says a new study by the National Institute for Health Research (NIHR) BRACE Rapid Evaluation Centre undertaken by researchers at the University of Birmingham and RAND Europe.

In July 2019, NHS England invited GP practices to join together into primary care networks and use new funding to offer extra services to improve the health and wellbeing of local communities. These services include pharmacists based within general practices, additional GP and nursing support for care homes, and ‘social prescribing’ where GPs can refer a patient for support such as exercise, counselling, weight loss, or befriending.

The newly published evaluation study was undertaken by a team from the University of Birmingham’s Health Services Management Centre and RAND Europe , funded by the NIHR Health Services and Delivery Research (HS&DR) Programme. The study produced early evidence of the development and implementation of primary care networks in their first year, and looked at how these networks were established, achievements so far, and what has helped or hindered progress.

The authors were particularly interested in the experience of primary care networks in rural areas, and how the networks fit in with other pre-existing types of collaboration such as GP federations and super-partnerships. In order to do this, the research team recruited four primary care networks as case studies where they carried out interviews, surveyed staff, observed meetings and reviewed reports and papers.

The report points to the importance of significant levels of new funding channelled into general practice through the networks as an important motivating factor for GPs and their teams. Primary care networks were able to rapidly establish governance and decision-making mechanisms, recruit staff for new roles and start to develop the services set out in national guidance.

The evaluation highlights how primary care networks need to build further leadership and management capacity from across wider primary care teams in order to assure their longer term sustainability, being careful not to rely too heavily on their GP clinical director. The research also points to a need for further clarification on what role primary care networks will play in the wider health and social care system, especially in the context of the Covid-19 pandemic and its aftermath.

Professor Judith Smith, lead author of the report says: "Our research revealed that primary care networks have made good progress in their first year, establishing their new organisation, recruiting staff, and preparing plans for more services in future years, including those that can enable more rapid diagnosis of cancer, and provide enhanced support for people living in care homes. They have however faced significant challenges, including playing a key role in the local primary care response to the Covid-19 pandemic. On a practical level, they have had to work out how to ensure sufficient management support, and address some tensions between national and local priorities for goals and direction of the networks, together with concerns about excessive workload.’

Sarah Parkinson, report co-author added: "We were able to speak to leaders of primary care networks from across the country about responses to Covid-19, which revealed that these networks were one of the mechanisms through which primary care responded to the pandemic. Primary care networks helped organise important measures such as ‘hot’ and ‘cold’ hubs for general practice care, remote working solutions, and centralised systems to triage patients to the most appropriate service. Moving forward, it will be important for primary care networks to explore what pandemic-focused services should be maintained longer term, and how Covid-19 has shaped the development of networks."

Dr Manbinder Sidhu, report co-author commented: “Understanding the vulnerability of rural primary care is essential - some primary care network leaders in our evaluation felt that policy had not fully embraced the scale of the challenge faced by those delivering care in rural areas. For example, some smaller rural practices reported facing an uphill challenge as they may lack the capacity to release staff to set up, operate or engage with the primary care network despite additional funding.’

The report ’Early evidence of the development of primary care networks in England: a rapid evaluation study ’ is authored by Professor Judith Smith , Director of the Health Services Management Centre at the University of Birmingham, Dr Manbinder Sidhu from the University of Birmingham, Sarah Parkinson and Amelia Harshfield from RAND Europe.