Questions

 A comprehensive review of primary care models in the NHS undertaken by the Health Service Journal reporter - Rebecca Thomas   

A recent analysis carried out looking at what models of large scale primary care exist cross England found there was very clearly a new show in town: the primary care network.

The idea of a primary care network in one form or another has been rehashed and reshaped over several decades, and it began to see a definite resurgence a couple of years into Simon Stevens’ five year plan. According to the latest trawl of large scale GP models, there are 344 primary care networks operating across 195 clinical commissioning groups in England. This was by far the most common model cited by CCGs, with GP federations – more in vogue a few years ago – a distant second at 216.

When Rebecca carried out similar work just last year, only 73 networks were identified by commissioners. The numbers are not precisely comparable, but there appears to have been a considerable surge. In part, undoubtedly, this is a result of NHS England putting a clear preference for primary care networks into policy, and CCGs earmarking some funding for scaled up primary care providers. The £6 per head of extended access money, for example, has been focused towards developing “hubs” across networks or clusters of practices.  However, that policy shift was itself a result of sensing where general practice was at, and what was realistic.

Compared to the core new care models set out in the Five Year Forward View – multi-specialty communities strongly resemble the network description – clusters of GP practices organising primary and community services around patient populations of 30,000 to 50,000.  According to the NAPC, there are now 209 PCH sites across England – considerable growth from the 15 rapid test sites launched in 2015. As with networks, GPs apparent comfort with the concept has been key to PCH’s spread.

The critical question is what comes next? Because primary care networks are crying out for a second act.

Ambitions for the next phase

The government has said that with NHSE, it will publish a long term plan for the NHS later this year, potentially as soon as July. General practice and wider primary care will have to be both community providers and primary and acute care systems – the more informal networks have seen much more organic growth.  They were also fuelled by the National Association of Primary Care’s primary care home model. Given the strides being made by the network concept – and its adoption at the top of NHSE – this will surely stay with us. It will have to outline how networks will become the basis of something a lot more ambitious, better defined and sustainable.

One set of questions is about the extended services to be provided at this level. Longstanding aspirations for community care suggest more outpatients, diagnostics and direct access therapies can coalesce with primary care networks. How can networks move beyond the politically popular but fairly rudimentary ask of coordinating extended opening hours?

Workforce is a major factor. How can the long promised tip in balance towards primary care be made real?

As is estates: will funding attached to the long-term plan result in a new building drive?

Major contracting changes for general practice are unlikely – the voluntary “accountable care” contract has been trouble enough – but there does need to be a pathway for governance and financial apparatus to develop around networks.  One option could be found in a successor to the quality and outcomes framework, shifting the incentive on to practices working together to provide preventative, integrated care.

Those setting out the next steps will remain mindful of the balance between going with the grain of general practice and pushing into a more ambitious second act for primary care networks.