Can Primary Care Networks contribute to the national goal of reducing health inequalities? A mixed method study

Background: Significant health inequalities exist in England. Primary care networks (PCNs), comprised of GP practices, were introduced in England in 2019 with funding linked to membership. PCNs are tasked with tackling health inequalities. Aim: We consider how the design and introduction of PCNs might influence their ability to tackle health inequalities. Design and Setting: A sequential mixed methods study of Primary Care Networks in England. Methods: Linear regression of annual PCN allocated funding per workload-weighted patient on income deprivation score from 2019-2023. Qualitative interviews and observations of PCNs and PCN staff were undertaken across seven PCN sites in England (July 2020-March 2022). Results: Across 1,243 networks in 2019-20, a 10% higher level of income deprivation resulted in £0.31 (£0.25, £0.37), 4.50%, less funding per weighted patient. In 2022-23, the same difference in deprivation resulted in £0.16 (£0.11, £0.21), 0.60%, more funding. Qualitative interviews highlighted that although there were requirements for PCNs to tackle health inequalities, the policy design and PCN internal relationships and maturity shaped and sometimes restricted how PCNs approached this locally. Conclusion: Allocated PCN funding has become more pro-poor over time, suggesting that the need to account for deprivation within funding models is understood by policy makers. We highlight additional approaches which could support PCNs to tackle inequalities: better management support; encouragement and support to redistribute funding internally to support practices serving more deprived populations; and greater specificity in service requirements.