Primary care networks: Exploring primary care commissioning and contracting

This research project is funded by the NIHR Policy Research Unit in the Health and Care System and Commissioning and will run from May 2019 to April 2022.

The NHS Long Term Plan, new GP contract, and NHS Operational Planning and Contracting Guidance 2019/20 set out a direction of travel for local NHS service commissioning and provision which suggests that primary care services will be increasingly delivered by collaborating networks of practices operating at what has been called ‘neighbourhood’ level, usually defined as covering populations of 30-50,000.

Whilst GP practices have collaborated together for a variety of purposes for many years, the new contract proposals envisage a closer working relationship than we have seen before, including: shared employment of staff; network-level contracts, payments and incentives; and collaboration over back-office functions. It is argued that these developments will support the integration of services between primary, community, secondary and social care, and ensure the sustainability of primary care services for the future, whilst improving the quality of services delivered to patients.

The timetable for these changes is short, with practices required to organise themselves into networks by June 2019.

This longitudinal project will explore the architecture being put in place to commission and contract for primary care services at neighbourhood level. It is important that these new initiatives are studied as they develop over time, whilst also providing timely and relevant feedback to support NHSE and DHSC.

The aim of this study is to understand the processes by which primary care services are commissioned, contracted for and delivered at neighbourhood level, and to explore the impact and outcomes of those processes.

Objectives:

• To understand the objectives underlying the current changes to primary care commissioning and contracting, and to explore the intended outcomes
• To explore the formation and operation of networks as part of an evolving policy landscape, including their impact on constituent practices, their accommodation alongside existing collaborative ventures, and their implications for other care providers
• To investigate the implementation of the contractual changes at local level, including mechanisms for support, monitoring, payment and contract management and to understand the factors affecting this
• To explore the mechanisms by which practices are working together across geographical neighbourhoods, including approaches to staff payment, recruitment and management, and the operation of network-level incentives
• To understand how networks of practices are engaging with other local service planning and provision at ‘neighbourhood’ level (including community and voluntary sector partners), ‘place’ level (typically borough or council scale and involving local government), and ‘system level’ (ie Integrated Care Systems (ICS), Sustainability and Transformation Partnerships (STP))
• To identify outcomes associated with the new arrangements, including staff and patient satisfaction, impacts on quality of care and effects on integration with other services.