The establishment of primary care networks throughout the Covid-19 pandemic: a qualitative exploration of workforce perceptions

Gates, Jessica (2024) The establishment of primary care networks throughout the Covid-19 pandemic: a qualitative exploration of workforce perceptions. Doctoral thesis, Northumbria University.

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Abstract

Background: Primary Care Networks (PCNs) are groups of GP practices operating together, who collaborate with external services in their local area. PCNs build on existing primary care services to encourage proactive and integrated care for people in their local areas. PCNs are crucial to developing integrated care systems and addressing goals set out in the NHS Long-Term Plan. PCNs were expected to address pressures on the NHS through workforce expansion. The overall aim of this research was to explore what factors might be perceived by the PCN workforce as enabling or hindering the success of a PCN. This PhD takes a qualitative approach to research, utilising three phases, and underpinned by social constructionism.

Phase 1: The systematic narrative review explored the provision of preventative healthcare services in UK primary care settings, through the lens of facilitators and barriers experienced by healthcare professionals. This review does not focus on one preventative service, and reflects common threads between services, providing a novel perspective. Twenty papers were included in the review. The main themes are organised using a micro-meso-macro structure and reflect individual, organisational and system barriers and enablers to the delivery of preventative care. The review considers the interaction between micro, meso and macro levels and the cumulative impact this can have upon service delivery.

Phase 2: Informed by the findings from Phase 1, Phase 2 involved semi-structured interviews with fifteen Participants (North Tyneside PCN workforce). Three main themes were generated through Framework Analysis (Gale et al., 2013): Working Together at Scale, Network Infrastructure, and PCN Leadership. Findings indicated that participants are making attempts at working together at scale, through pooling resources and trying to foster a culture of collaboration. Participants reflected on the impact PCNs have had on their role and colleagues, as well as patients. While participants were accepting of the idea of collaboration, they were hindered by issues relating to network infrastructure. A major impact was seen from the lack of legal status associated with PCNs, the workforce crisis and resourcing. Nevertheless, participants reflected on service developments and how they were trying to deliver against NHS England's expectations. PCN Clinical Directors demonstrated a passion for service improvement, however also reflected on the psychological impact they have felt because of this role. The COVID-19 pandemic is a contextual thread that runs throughout this Phase.

Phase 3: Phase 3 involved follow-up interviews with five of the original fifteen participants. The Framework generated in Phase 2 followed through into Phase 3, and three themes were generated: Working Together At Scale, Network Infrastructure, and PCN Leadership. Findings indicated that practice to practice collaboration continues and has been extended to include collaborating as a collective of PCNs. Participants reflected more positively on changes to workload as a result of the ARRS roles and remarked on the lasting impact of the COVID-19 pandemic, though they continued to perceive themselves to be hampered by the non-legal status of PCNs and the workforce crisis. Participants reflected upon the abolishment of CCGs and how this may impact primary care. Findings also indicated there have been further service developments. PCN Clinical Directors reflected again on the psychological impact of the role, alongside coping strategies and mitigating factors. There had been several changes in PCN leadership in the area, and participants reflected on the impact of this.

Conclusion: By integrating findings from Phases 1, 2 and 3, and drawing on concepts from Complex Adaptive Systems theory, a theoretical model has been developed to conceptualise the findings from this thesis. This theoretical model is the original contribution to knowledge. Recommendations for practice, policy and future research have been developed based on the findings from this thesis, alongside learnings from the COVID-19 pandemic. The COVID-19 pandemic fundamentally changed my PhD project's nature and presented both challenges and opportunities. COVID-19 allowed insights and perceptions that perhaps would not have been possible pre-pandemic, offering a novel lens through which to view how staff experience change. This PhD was exploring the establishment of PCNs, during a period when a rapid pace of change was happening in the NHS for the pandemic response.

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