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

Checkland, Kath, Bramwell, Donna, Warwick-Giles, Lynsey, Bailey, Simon, Hammond, Jonathan (2023) Primary Care Networks as a means of supporting primary care: findings from qualitative case study-based evaluation in the English NHS. BMJ Open, 13 (11). Article Number e075111. E-ISSN 2044-6055. (doi:10.1136/bmjopen-2023-075111) (KAR id:103010)

Abstract

Objectives This study aimed to evaluate primary care networks (PCNs) in the English National Health Service. 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 PCN in England, chosen for maximum variety around geography, rurality and population deprivation. Study took place between May 2019 and December 2022.

Participants PCN members, staff employed in additional roles and local managers. Ninety-one semistructured 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. While 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.

Item Type: Article
DOI/Identification number: 10.1136/bmjopen-2023-075111
Uncontrolled keywords: Humans, Qualitative Research, England, Primary Health Care, State Medicine, organisation of health services, primary care, Government Programs, health policy
Subjects: H Social Sciences
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
Funders: University of Kent (https://ror.org/00xkeyj56)
Depositing User: Milly Massoura
Date Deposited: 27 Sep 2023 11:07 UTC
Last Modified: 01 Mar 2024 11:33 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/103010 (The current URI for this page, for reference purposes)

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