Exploring the multiple policy objectives for primary care networks: a qualitative interview study with national policy stakeholders

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Abstract

Objectives
English general practice is suffering a workforce crisis, with GPs retiring early and trainees reluctant to enter the profession. To address this, additional funding has been offered, but only through participation in collaborations known as Primary Care Networks (PCNs). This study explored national policy objectives underpinning PCNs, and mechanisms expected to help achieve these, from the perspective of those driving the policy.

Design
Qualitative semi-structured interviews and policy document analysis.

Setting and participants
National level policy maker and stakeholder interviewees (n=16). Policy document analysis of Network Contract Direct Enhanced Service draft service specifications.

Analysis
Interviews were transcribed, coded, and organised thematically according to policy objectives and mechanisms. Thematic data was organised into a matrix so prominent elements to be identified and emphasised accordingly. Themes were considered alongside objectives embedded in PCN draft service delivery requirements.

Results
Three themes of policy objectives and associated mechanisms were identified:(1) Supporting general practice;(2) Place-based inter-organisational collaboration;(3) Primary care ‘voice’. Interviewees emphasised and sequenced themes differently suggesting meeting objectives for one was necessary to realise another. Interviewees most closely linked to primary care emphasised the importance of(1). The objectives embedded in draft service delivery requirements primarily emphasised(2).

Conclusions
These policy objectives are not mutually exclusive but may imply different approaches to prioritising investment or necessitate more explicit temporal sequencing, with the stabilisation of a struggling primary care sector probably needing to occur before meaningful engagement with other community service providers can be achieved or a ‘collective voice’ is agreed. Multiple objectives create space for stakeholders to feel dissatisfied when implementation details do not match expectations, as the negative reaction to draft service delivery requirements illustrates. Our study offers policy makers suggestions about how confidence in the policy might be restored by crafting delivery requirements so all groups see opportunities to meet favoured objectives.

Bibliographical metadata

Original languageEnglish
JournalBMJ Open
DOIs
Publication statusPublished - 5 Jul 2020