Across all organisations there is a global movement from hierarchies to highly networked forms. As the world becomes more global, and problems more complex organisations are working together in (multiple) networked systems. Organisations will have at minimum learning partners working together in learning networks; delivery partners working together to deliver services across populations.
Innovation requires collaboration.
Integrated Care can be delivered more effectively through a network model. This approach needs to bring multiple delivery partners together to collaborate as peers to deliver innovations in services, and to learn together. These ‘Developmental’ networks (Malby & Mervyn 2012) are good at focusing effort at a system level and enabling collaborations between organisations where there is no one accountable organisation and where members redesign together. Leadership here is systems leadership. Accountability and governance now rests at two levels:
- With organisational member boards (General Practice in PCNs) for their own financial and clinical responsibilities
- With the peer network members for delivery of the whole
This approach should bring flexibility and adaptability.
However these models will fail if they are performance managed as a hierarchy. Where the work requires innovation, collaboration, learning and adaptation networks will deliver. However if there is a ‘master plan’ that requires implementing then networks will not deliver.
The confusion over the Primary Care Networks in the UK reflect this. If PCNs are a delivery mechanism for central policy then a hierarchical model is needed with individual practices relinquishing authority to an executive leadership group (a group model). If PCNs are to meet complex care needs collaboratively then this requires agility and emergent innovation, and a network form is the better option, but this does require sophisticated systems leadership as peers (see the associated resources on systems leadership).
For these networks made up of organisations with strong hierarchies the pitfalls relate to the usual issues in networks – that whilst they can be agile and creative forms they take effort to develop the relationships, they can’t solve capacity problems at the outset, they can only do so as they begin to innovate together, they can have a complex decision-making process, and they are dependent on agreements between members being binding.You can listen to a podcast on the challenges of navigating multiple purposes through a collaborative networks here: https://ockham.healthcare/podcast-becky-malby-six-months-in-the-life-of-pcns
How PCNs can solve the problems in primary care is set out in Prof Malby's blog  which sets out the emerging purpose of PCNs to work collaboratively to:
- Meet complex needs through integration, and secure access for marginalised people
- Improve the quality of care for the whole population
- Support sustainable general practice and a resilient workforce
- Empower communities
These require a negotiated collaboraton between general practice, and between the practices and associated partner providers (e.g. mental health, social care, third sector). This requires sophisticated network approaches to meet population health needs.
Where these place based networks work well there is a clear commitment and interest in the collective outcome, they invest in members who can understand multiple members views and can bring those views and issues together facilitating inter-group relationships and surface and work with inter-group conflict. At the core is the agreed task of the network.
Additional blogs, intelligence and case studies can be found in the resources section - Spotlight on integrated care networks, which is updated on a regular basis.
Malby, R., Mervyn, K. (2012) Networks – A briefing paper for The Health Foundation. University of Leeds.
Malby B (2020) Solving the Problems in Primary Care. Blog. https://beckymalby.wordpress.com/2020/01/23/solving-the-problems-in-primary-care/ 23 January