Investigating the impact of primary care networks on continuity of care in English general practice: analysis of interviews with patients and clinicians from a mixed methods study

Introduction
In England primary care networks (PCNs) offer opportunities to improve access to and sustainability of general practice through collaboration between groups of practices to provide care with a broader range of practitioner roles. However, there are concerns that these changes may undermine continuity of care. Our study investigates what the organisational shift to PCNs means for continuity of care.
Methods
The paper uses thematic analysis of qualitative data from interviews with GPs and other healthcare professionals (n=33) in 19 practices in five PCNs, and their patients (n=35). Three patient cohorts within each participating practice were recruited, based on anticipated higher or lower needs for continuity of care: patients over 65 years with polypharmacy, patients with anxiety or depression and ‘working age’ adults aged between 18 and 45 years.
Findings
Patients and clinicians perceived changes to continuity in PCNs in our study. Larger-scale care provision in PCNs required better care coordination and information sharing processes, aimed at improving care for ‘vulnerable’ patients in target groups. However, new working arrangements and ways of delivering care in PCNs undermine healthcare professionals’ ability to maintain continuity through ongoing relationships with patients. Patients experience this in terms of reduced availability of their preferred clinician, inefficiencies in care and unfamiliarity of new staff, roles and processes.
Conclusions
New practitioners need to be effectively integrated to support effective team-based care. However, for patients, especially those not deemed ‘vulnerable’, this may not be sufficient to counter the loss of relationship with their practice. Therefore, caution is required in relation to designating patients as in need of, or not in need of continuity. Rather, continuity for all patients could be maintained through a dynamic understanding of need for it as fluctuating and situational and by supporting clinicians to provide follow up care.
Patient and public involvement
A Patient and Public Involvement (PPI) group were recruited and consulted during the study for feedback on the study design, recruitment materials and interpretation of findings.