Understanding primary care networks

Understanding primary care networks: context, benefits and risks |  The Health Foundation


This briefing places Primary Care Networks (PCNs)  in the context of previous changes to general practice funding and contracting. It examines the rationale for networks, explores relevant evidence and draws out intended benefits and possible risks for the future of PCNs.

Key points
  • From 1 July 2019, all patients in England will be covered by a primary care network (PCN) – the most significant reform to general practice in England in a generation.
  • PCNs should help to integrate primary care with secondary and community services, and bridge a gap between general practice and emerging Integrated Care Systems.
  • Since January 2019, practices have been organising themselves into local networks to provide care at greater scale by sharing staff and some of their funding.
  • While PCNs offer huge potential to integrate care and improve services, there is a risk that the speed of implementation will undermine the best intentions of the policy.

Full briefing: Understanding primary care networks . Context, benefits and risks

Additional link: NHS England press release | NHS England blog


Improving primary care access out of hours

Improving access out of hours: evaluation of extended-hours primary care access hubs | The Nuffield Trust 

This report explores whether schemes aiming to increase the availability of primary care access out of hours improved the overall quality of services and patient experience in north London. Barking and Dagenham, Havering and Redbridge CCGs commissioned this report to evaluate the impact of access programmes in their areas.

Key findings

  • Most of the patients interviewed told the researchers that they had chosen to attend the hubs because they found it difficult to attend in-hours primary care services. Others said that they had wanted a speedy clinical assessment for themselves or their children.
  • Patients particularly liked the appointment-based system at the hubs and this was what they highlighted when distinguishing between the hubs and other services such as walk-in centres and A&E departments.
  • Since the hubs opened, there has been an increase in the use of A&E services across the boroughs. However, during the research the size of this increase appeared to be associated with hub attendance in that it was significantly lower in areas where hub attendance was highest by approximately 4.5%. This suggests that the presence of the hubs may have been diverting some people who would otherwise choose to attend A&E, or who may have been sent to A&E by NHS 111, away from this service.
  • However, from a commissioning perspective, such reductions in A&E attendance would not be enough to offset the local cost of providing the hub service.
  • During the study, a call centre had been introduced to improve the appointment booking process. By 2016, between 80% and 90% of patients attending the hubs were recorded as self-referrals, presumably because they had used the call centre. The number of referrals from NHS 111 had remained more stable and generally not increased as new hubs opened.
  • The hubs had adapted to lower demand on Sundays by reducing opening hours and staffing, thus ensuring that Sunday usage rates were comparable to usage rates on other days of the week.
  • Some staff working at the hubs raised concerns about their lack of access to patients’ medical records and their inability to refer patients on for further treatment. Both these areas require effective systems to be in place to avoid the potential of increased clinical risk.
  • Survey responses from staff working at the hubs revealed a largely positive attitude towards working at the hubs, with 59% of staff saying that working at the hubs was better than their other or previous work.
  • It is possible that the hub scheme may have had an effect on the locum market in the area: some staff not working at the hubs suggested that higher locum rates being paid to hub staff might reduce the availability of locums for in-hours work.

Full report:
Improving access out of hours: Evaluation of extended-hours primary care access hubs

The primary care network handbook

This handbook offers options to groups of practices looking to establish a primary care network (PCN) British Medical Association (BMA)

PCNs are groups of general practices working closely together, with other primary and community care staff and health and care organisations, providing integrated services to their local populations. The BMA have created a handbook which provides advice and offers options to groups of practices looking to establish a PCN.

pcn handbook
Image source: http://www.bma.org.uk

It includes detailed guidance on

  • Governance structures
  • Internal governance and decision making
  • Potential PCN structures and employment options
  • PCN funding
  • PCN future workforce options

Full document: The primary care network handbook

Further detail: Primary Care Networks (PCNs) | BMA

GP practices free up 3,000 extra patient appointments through Primary Care Network

GP practices in Luton have worked together to provide more than 3,000 extra appointments a year including halving the number of appointments lost due to patient non-attendance | via NHS England

As well as freeing up appointments, the Primary Care Network (PCNs) model has led to friends and family satisfaction with services being positive nine times out of ten, while complaints have fallen by 12 per cent and £50,000 has been saved.

To achieve this, the GPs made a number of changes including altering the types of healthcare professionals in the practice, offering alternative appointments where appropriate and introducing long term conditions clinics.

PCNs are one of the new national approaches unveiled in the NHS’ long term plan this week. In Luton’s PCN, groups of GP practices pool their skills and resources to provide patients with access to more health professionals including GPs, pharmacists, paramedics, physicians associates and specialist doctors.

They can treat patients for a wide range of illnesses, ensuring they see the right person from the start and freeing up the GPs to spend more time with patients who have complex needs.

Full story at NHS England

Primary mental health care

Filling the chasm: reimagining primary mental health care | Centre for Mental Health

This report explores local initiatives which bridge the gap between primary care and secondary care mental health services, supporting people have more complex needs, don’t meet secondary care thresholds, or present with multiple or medically unexplained symptoms.

Image source: http://www.centreformentalhealth.org.uk

It finds that primary care services in many areas of England have developed a number of different approaches to addressing mental health needs that other services do not meet. The report describes promising approaches in eight local areas.

The report calls on NHS England to make primary mental health care a central strand of the long-term NHS plan, due to be published later this month. The NHS needs to identify effective models of primary mental health care and invest in local services to help them meet the needs of their communities. The report also calls on Health Education England to invest in the workforce for primary mental health care.

The report identified some key elements for future primary care developments:

  • Identifying the opportunities for prevention and promotion of mental health – including in the perinatal period; with children and young people; and through providing information and resources
  • Maximising social interventions for mental health – moving away from anti-depressants and therapy as the only solutions, improving awareness of community resources
  • Culture change – embracing the holistic approach – valuing social support and linking to physical health initiatives
  • Empowering the person – moving ‘from patient to person’ – enabling people to make their own decisions about what they need to focus on, addressing social factors and causes of mental health problems
  • Bridging the gap between primary and secondary care – co-locating services, employing senior staff to provide consultancy and supervision

Full report: Filling the chasm. Reimagining primary mental health care | Centre for Mental Health


Primary care quality assurance – South Nottinghamshire

NHS England | September 2018 |Primary care quality assurance – South Nottinghamshire

A new case study on the Atlas of Shared Learning shows how a  consistent quality assurance approach is being established  by Nurses in a CCG team in Nottinghamshire. This arose as nurses within the Quality Team identified unwarranted variation within primary care practices in the broad areas of quality, safety, clinical effectiveness and patient experience, where there was no uniformed process to review effectiveness and safety across GP practices across the CCG area.


The implementation of a quality assurance and improvement framework enabled the CCG nurses to target resources and support towards GP practices that needed greater support to achieve effective and safe practice, which is driving improvements and enhancing safety within the practices.

Read the full news story at NHS England 

C the Signs – How artificial intelligence (AI) is supporting referrals

NHS England | August 2018 | C the Signs – How artificial intelligence (AI) is supporting referrals

C the signs is an app that uses artificial intelligence mapped with the latest NICE guidelines and other evidence to provide GPs with the ability to check combinations of signs, symptoms and risk factors of cancer in an easy-to-use format. The app can be accessed on desktop computers or mobile phones, GPs can access the tool during the consultation to identify which referrals and investigations patients need. This has led to improved GP consultations and a smoother referral process as the app is designed to support  GPs to identify patients at risk of cancer earlier.board-1364652_1920.jpg

As a result of a  successful trial of the app in Sutton, the app will now be piloted in other areas, meaning that GPs and practice nurses in 95 practices will be given access to the tool and be able to use in consultations with their patients (Source: NHS England).


Of interest:

Royal College of General Physicians Artificial intelligence (AI) in health
In the media:

OnMedica Guidance needed to evaluate AI used to support patient care