Planning and managing primary care services: lessons from the NHS in England

Checkland, Kath; McDermott, Imelda; Coleman, Anna; Warwick-Giles, Lynsey; Bramwell, Donna; Allen, Pauline; Peckham, Stephen

doi:10.1080/09540962.2018.1449467

Cited by 12 publications

(19 citation statements)

References 22 publications

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“…The current primary care system in England, whereby GPs are contractors to the NHS, was born out of the decision made at the establishment of the NHS in 1947 7. This enabled GPs to remain independent to the NHS, minimising their opposition to the NHS 9 10.…”

Section: History Of Commissioning Of Primary Care Services In Englandmentioning

confidence: 99%

“…This enabled GPs to remain independent to the NHS, minimising their opposition to the NHS 9 10. There was little planning for GP services from 1948 to 1990 7. GPs were contracted as individuals and payment were governed by the number of registered patients and by the services provided.…”

Section: History Of Commissioning Of Primary Care Services In Englandmentioning

confidence: 99%

“…The HSCA12 gave responsibility for commissioning primary care services to a new national body, NHSE. However, it proved difficult for this national body to actively commission services to meet local needs,7 and in May 2014, following the appointment of Simon Stevens as the chief executive of NHSE, CCGs were given ‘new powers’ to take on a greater role in commissioning of primary care services (known as primary care co-commissioning). This would enable CCGs to take on a more integrated approach and ‘unlock the full potential of their (CCGs’) statutory duty’ 14.…”

Section: Current Policy Contextmentioning

confidence: 99%

“…This means the planning and managing of primary care services should involve contracting and procurement and clinically led service redesign and engagement with local stakeholders 6. Hence contractual mechanisms and incentives used would have a significant impact on the way that services are delivered and therefore on the way they interact with other sectors 7 8…”

Section: Introductionmentioning

confidence: 99%

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Achieving integrated care through commissioning of primary care services in the English NHS: a qualitative analysis

et al. 2019

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ObjectivesSince April 2015, Clinical Commissioning Groups (CCGs) have taken on the responsibility to commission primary care services. The aim of this paper is to analyse how CCGs have responded to this new responsibility and to identify challenges and factors that facilitated or inhibited achievement of integrated care systems.DesignWe undertook an exploratory approach, combining data from interviews and national telephone surveys, with analysis of policy documents and case studies in four CCGs. Data were analysed using thematic content analysis.Setting/participantsWe reviewed 147 CCG application documents and conducted two national telephone surveys with CCGs (n=49 and n=21). We interviewed 6 senior policymakers and 42 CCG staff who were involved in primary care co-commissioning (general practitioners and managers). We observed 74 primary care commissioning committee meetings and their subgroups (approx. 111 hours).ResultsCCGs in our case studies focused their primary care commissioning activities on developing strategic plans, ‘new’ primary care initiatives, and dealing with legacy work. Many plans focused on incentivising and supporting practices to work together and provide a broad range of services. There was a clear focus on ensuring the sustainability of general practice. Our respondents expressed mixed views as to what new collaborative service models, such as the new models of care and sustainability and transformation partnerships (STPs), would mean for the future of primary care and the impact they could have on CCGs and their members.ConclusionsThere is a disconnect between locally based primary care and the wider system. One of the major challenges we identified is the lack of knowledge and expertise in the field of primary care at STP level. While primary care commissioning by CCGs seems to be supporting local collaborations between practices, there is some way to go before this is translated into broader integration initiatives across wider footprints.

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Section: History Of Commissioning Of Primary Care Services In Englandmentioning

confidence: 99%

Section: History Of Commissioning Of Primary Care Services In Englandmentioning

confidence: 99%

Section: Current Policy Contextmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Achieving integrated care through commissioning of primary care services in the English NHS: a qualitative analysis

et al. 2019

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“…NHSE has delegated the operational side of primary care commissioning to CCGs, with CCGs assuming varying levels of responsibility (England 2014b). Consequently, there are no clear boundaries between what would be considered a regulatory agency and an 'extra-state' entity as commissioning responsibility for primary healthcare becomes intermingled between NHSE and CCGs to varying degrees (Checkland, McDermott, et al 2018).…”

Section: An Evolving Organizational Landscapementioning

confidence: 99%

Not every public sector is a field: evidence from the recent overhaul of the English NHS

Gore

Hammond

Bailey

et al. 2018

Public Management Review

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A structural interpretation of institutionalism has become dominant in public management research. Yet, studies tend to assume an institutional-level phenomenon without specifying how an organizational field was identified or whether structural characteristics can indeed be found in the organizational population studied. This lacuna is illustrated by exploring the structural interpretation of the field construct in the case of the recent overhaul of English primary care. Findings demonstrate the need for a more robust application of institutionalism in empirical research. Possible research problems for public management and a future research agenda based on a more relational approach to fields are discussed.

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‘Real-world’ priority setting for service improvement in English primary care: a decentred approach

Kislov

Checkland

Wilson

et al. 2021

Public Management Review

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This article develops an analysis of population-level priority setting informed by Bevir's decentred theory of governance and drawing on a qualitative study of priority setting for service improvement conducted in the complex multi-layered governance context of English primary care. We show how powerful actors, operating at the meso-level, utilize pluralistic and contradictory elements of complex governance networks to discursively construct, legitimize and enact service improvement priorities. Our analysis highlights the role of situated agency in integrating top-down, bottom-up and horizontal influences on priority setting, which leads to variation in local priorities despite the continuous presence of strong hierarchical influences.

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Planning and managing primary care services: lessons from the NHS in England

Cited by 12 publications

References 22 publications

Achieving integrated care through commissioning of primary care services in the English NHS: a qualitative analysis

Achieving integrated care through commissioning of primary care services in the English NHS: a qualitative analysis

Not every public sector is a field: evidence from the recent overhaul of the English NHS

‘Real-world’ priority setting for service improvement in English primary care: a decentred approach

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