Exploring commissioners’ understandings of early Primary Care Network development: qualitative interview study

Abstract

Background: Primary Care Networks (PCNs) are financially incentivised groupings of General Practices (GP) in the English NHS. Their purpose is to deliver a number of policy goals set out in the NHS Long Term Plan. Clinical Commissioning Groups (CCGs) have a role in their establishment, support, and oversight. Aim: Explore commissioner’s perspectives on the early development of PCNs. Design and Setting: Qualitative study of CCGs using telephone interviews. Semi-structured interviews (n=37) with CCG employees involved in PCN establishment. Method: Interviewees were asked about local PCNs’ characteristics, factors shaping development and form, activities to date, challenges and benefits, and their CCGs’ relationship with PCNs. Interviewee responses were summarised within a matrix and analysed thematically. Results: Three meta-themes were identified: the multifaceted role of the commissioner; uneven advantages; engaging the broader system. Interviewees reported that the policy potentially favours PCNs working from a ‘blank slate’ and does not sufficiently account for the fact some GP practices and wider system organisations have been doing similar work already. The prescriptive, contractual nature of the policy has led to local challenges, trying to ensure local good practices are not lost during implementation. Interviewees also considered an important part of their work to be protecting PCNs from the weight of expectations placed upon them. Conclusion: CCGs are well placed to understand the complexities of local systems and facilitate PCNs and working practices between wider system partners. It is important that this local role is not lost as CCGs continue to merge and cover larger geographical populations.