Variability in size and characteristics of primary care networks in England: observational study

Abstract

BackgroundGeneral practices in England have been encouraged by national policy to work together on a larger scale by creating primary care networks (PCNs). Policy guidance recommended that they should serve populations of 30 000–50 000 people to perform effectively.AimTo describe variation in the size and characteristics of PCNs and their populations.Design and settingCross-sectional analysis in England.MethodUsing published information from January 2020, PCNs were identified that contained <30 000, between 30 000–50 000, and >50 000 people. Percentiles were calculated to describe variation in size and population characteristics. PCN composition within each commissioning region was also examined.ResultsIn total, 6758 practices had formed 1250 PCNs. Seven hundred and twenty-six (58%) PCNs had the recommended population of 30 000–50 000 people. Eighty-four (7%) PCNs contained <30 000 people. Four hundred and forty (35%) PCNs contained >50 000 people. Thirty-four (3%) PCNs comprised just one practice and 77 (6%) PCNs contained >10 practices. Some PCNs contained more than double the proportions of older people and people with chronic conditions compared to other PCNs. More than half of the population were from very socioeconomically deprived areas in 172 (14%) PCNs. Only six (4%) of the 135 commissioning regions ensured all PCNs were in the recommended population range. All practices had joined a single PCN in three (2%) commissioning regions.ConclusionMore than 40% of the PCNs were not of the recommended size, and there was substantial variation in their composition and characteristics. This high variability between PCNs is a risk to their future performance.