Primary Care Networks as a means of supporting primary care: findings from qualitative case study-based evaluation in the English NHS

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To evaluate Primary Care Networks in the English NHS. We ask: How are PCNs constituted to meet their defined goals? What factors can be discerned as affecting their ability to deliver benefits to the community, the network as a whole and individual members? What outcomes or outputs are associated with PCNs so far? We draw policy lessons for PCN design and oversight, and consider the utility of the chosen evaluative framework.

Design and setting: 
Qualitative case studies in seven Primary Care Networks in England, chosen for maximum variety around geography, rurality and population deprivation. Study took place between May 2019 and Dec 2022.

Participants: Primary Care Network members, staff employed in Additional Roles and local managers. Ninety-one semi structured interviews and approximately 87 hours of observations were undertaken remotely. Interview transcripts and observational field notes were analysed together using a framework approach. Initial codes were derived from our evaluation framework, with inductive coding of new concepts during the analysis.

Results: PCNs have been successfully established across England, with considerable variation in structure and operation. Progress is variable, with a number of factors affecting this. Good managerial support was helpful for PCN development. The requirement to work together to meet the specific threat of the global pandemic did, in many cases, generate a virtuous cycle by which the experience of working together built trust and legitimacy. The internal dynamics of networks require attention. Pre-existing strong relationships provided a significant advantage. Whilst policy cannot legislate to create such relationships, awareness of their presence/absence is important.

Conclusions: Networked approaches to service delivery are popular in many health systems. Our use of an explicit evaluation framework supports the extrapolation of our findings to networks elsewhere. We found the framework to be useful in structuring our study but suggest some modifications for future use. 

Original languageEnglish
JournalBMJ Open
Early online date21 Nov 2023
Publication statusE-pub ahead of print - 21 Nov 2023


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