Stronger together: The impact of formal networks on GP practice’s funding, workforce and adoption of technology

Introduction: There is a recent change from competition to collaboration in the English primary care market. Integrated Care Systems were established in July 2022 to encourage and enable collaboration between local organisations. However, the focus on collaboration within primary care started with Primary Care Networks (PCNs) in 2019 and before that with Federations in 2010. As part of the NHS Long Term Plan, PCNs were established on 1st July 2019, marking a significant reorganisation of primary care services across the UK. One of the fundamental changes was thechanges in the 2019 General Practitioner contract, which paved the way for GP practices to join networks. However, this was preceded by the formation of Federations in 2010 to fulfil the Five-Year Forward View proposals that the English NHS should envisage delivering primary care on a larger scale than the traditional GP practice list.

Objective: Explore the role of primary care collaboration in funding and workforce, considering the impact of GP practices belonging to these two networks: Federations and PCNs. Methods We use an IV framework to estimate the impact of PCNs on GP practices funding, workforce and adoption of technology. The first stage regression is a network analysis model of the PCN formation while the second stage is a spatial Durbin model. We test also a specification with two different weight matrices: the strong relationship matrix, which defines that GP practices belong to the same PCN and Federation, and the weaker relationship matrix, which defines that GP practices belong to the same PCN but a different Federation (or no Federation). This approach allows the disentangling of the two sources of networks and easily tests for the existence of power in collaboration.

Results: Our results show robust evidence of a significant and positive spatial coefficient for the stronger relationship effect, confirming the importance of collaborations before PCNs to enhance the impact of incentives.