Primary care provider collaboratives: what you need to know
Key points
In response to the changing health and care system, primary care providers are coming together within systems to form collaboratives. These collaboratives are supporting integrated care systems’ (ICSs) strategic objectives and creating a much-needed voice for primary care at system level.
Several systems have invested in these collaboratives by providing funding, support and recognition of the important role they can play. As a result, they have been able to increase primary care’s involvement in system decision-making. This has enabled unified and accountable primary care representation, improved primary care resilience and new opportunities to collaborate with partners.
Collaboratives take different forms across the country, but do not currently operate everywhere. Without commitment to develop, resource and maintain these collaborations, there is a risk they become ineffective or never get off the ground. They require resource and legitimacy, commitment and leadership from primary care providers, and empowerment.
These collaboratives can create a genuine golden thread from community-level providers of primary care to systems. Given that primary care is the front door to the NHS, these collaboratives can pave the way to truly locally led decision-making.
For primary care to be empowered, connected and respected, a strong primary care voice within systems is vital. This is particularly true as we shift towards a population health-focused approach to service planning. Primary care provider collaboratives at system level can be the mechanism for this new voice and role.
This briefing from the Primary Care Network explores their role in detail.
What are primary care provider collaboratives?
The term ‘primary care provider collaboratives’ could cover any type of collaboration between providers of primary care services at any scale and of any size. There is evidence of a growth in collaboratives at both place and system. It is likely that this is where some of the confusion around primary care provider collaboratives has stemmed from.
A primary care network is a provider collaborative, as is a GP federation. However, in this context, we are specifically referring to primary care providers that come together to operate at a system level, under a unified collaborative, often also named ‘primary care boards’. In many areas these started as general practice collaboratives. But increasingly, collaboratives are encompassing wider primary care, including community pharmacy, optometry and dentistry.
Unlike mental health and acute trusts, when integrated care systems (ICSs) were formed there were no requirements for primary care to be part of provider collaboratives. Unlike community trusts and ambulance trusts there was no explicit reference to primary care providers needing to be involved in provider collaboratives as part of NHS England’s 2021 guidance. Therefore, where these collaboratives exist, they have formed from a need identified by primary providers or through a commitment by the integrated care board (ICB) to develop a system-level voice for primary care.
Why are they needed?
With 90 per cent of patient contacts taking place in primary care - and new NHS Confederation research with Carnall Farrar showing that for every £1 invested in community or primary care, up to £14 is returned back to the economy - system and primary care leaders have a responsibility to ensure primary care insight and expertise helps to inform decisions made at all levels.
The Fuller stocktake stated that systems should develop a primary care forum or network at system level, with suitable credibility and breadth of views to be able to advise ICSs in future planning and decision-making.
Collaboratives can go further than simply being a forum. Primary care’s agility and effectiveness is often attributed to its scale and reach, being close to the communities it serves, knowing its patients and the services needed to deliver the best outcomes for patients in the most cost-effective way. Primary care provider collaboratives can enable and empower this approach by bringing local providers together and closer to decision-making, strengthening the capabilities and voice of primary care.
A unified voice
A strong voice for primary care at system level, which is representative of its component parts, is essential if system priorities are to be developed based on local need and rooted in what matters to communities. Enabling a collective voice for primary care helps remove many of the barriers to engagement and collaboration caused by the perceived complexity of the primary care system.
The statutory requirement for a primary care partner member on the ICB has been interpreted differently across systems. While this role was not intended to be representative of primary care providers, some ICBs have adopted this approach by encouraging the ICB partner(s) to:
act as a spokesperson for primary care
build the provider collaborative structure to act as their sounding board or advisory group
in many cases, act as chair of the collaborative.
Where this does not take place, it remains important for primary care providers to have a voice within the ICBs. How this is organised should be locally determined, but it is key that primary care is heard and accounted for in the same way as trusts and other health and care partners.
Spotlight: North East and North Cumbria primary care collaborative
Primary care organisations across the North East and North Cumbria ICB have come together to develop a united and cohesive primary care view to engage in the development and delivery of the ICS strategy as an equal and confident partner. It will lead a culture of continuous improvement and innovation in primary care and ensure that it develops across the whole primary care sector, including pharmacy, optometry, and dentistry.
It will provide the mechanism to co-design strategy and opportunities for improving the services offered by primary care across the ICS and be the conduit for the representative voice for primary care into the ICS ensuring primary care is influencing and supporting ICS decision making. It will also work with and influence the work of other provider and clinical networks across the NENC footprint.
Greater accountability at all levels
Our Primary Care Network members have raised that there remains a top-down approach and relationship within the health and care system. Additionally, the lack of parity of esteem between secondary care trusts and other providers makes it difficult to have shared decision-making and accountability across systems. To truly achieve a locally led, system-enabled approach there needs to be greater vertical accountability and relational change.
In the ICS Network’s recent report on the state of integrated care systems, system leaders believed that primary care networks (PCNs) do not have the maturity or resources to help deliver the four main aims of integrated care systems. We also heard that members felt there had been a reduction in the delegation of powers in the last year.
System-level primary care provider collaboratives can create the golden thread of accountability from practices, through place and to systems. With the right levels of commitment, they can create the mechanism for delegation. Where resourced to do so, they can support practices and PCNs, create a communication channel to share insight and build improved leadership opportunities for the primary care workforce.
Spotlight: Greater Manchester Primary Care Provider Board
Through cross-system engagement, the Greater Manchester Primary Care Provider Board (GMPCB) has built a Greater Manchester Primary Care Blueprint. The collective plan details the key areas of focus for primary care improvement and transformation. Resourced by the system, the GMPCB will be responsible for the implementation of the blueprint across all the primary care system.
Alongside designing their future models, the board has organised a PCN Development Programme (delivered by NHS Confederation), designed in response to the needs expressed by PCNs, and in line with the blueprint, the Integrated Care Partnership Strategy and the national Fuller stocktake report. The board is leading both the discussions on the future of primary care and the implementation of reform and improvement programmes to deliver action.
At-scale service delivery
At-scale primary care service delivery helps reduce pressure on practice-level service providers so they can best deliver personalised care close to home and deliver the best outcomes tailored to the specific needs of their population. Delivering services at scale can:
increase the resilience of services
offer equity of access across an area
make collaborative approaches between secondary and primary care easier – reducing duplicative efforts, through needing to engage with multiple small primary care providers.
PCNs and GP federations are delivering at-scale services and support across neighbourhoods and places. But as provider collaboratives across systems grow there is also an opportunity to optimise this scale, where appropriate to do so. This allows primary care services to be commissioned at system level while also being able to delegate implementation and delivery through collaboratives, so delivery plans can be informed by local need.
Spotlight: Black Country Primary Care Collaborative
The Black Country Primary Care Collaborative led a winter access programme. It allocated £1 million across the four places and asked each place to design what they would like to deliver. As a result, two places set up a respiratory hub for children known as an Acute Respiratory Infection (ARI) hub, and Wolverhampton and Walsall set up general access hubs. The programme has provided “much more capacity, increased traffic to face-to-face and virtual appointments, and alleviated pressure on emergency services during winter.”
Cross-system integration is vital to managing the future health needs of system populations. However, the lack of understanding of how primary care operates should not be underestimated. Leaders of a number of primary care provider collaboratives have told us of the need to improve this understanding within their systems. This may seem a simple step, but greater awareness enables better-informed decisions and aids relationship-building across different parts of the sector.
Equally, the interdependence and interrelationships between different parts and scales of primary care can be complex; it is not always clear how other system partners can engage with primary care at place or system level. These types of collaboratives provide a route to engage and collaborate.
Primary care providers are, in some areas, involved in cross-sector provider collaboratives at place and system helping to improve integration across care pathways or for specific cohorts of patients. Where they are developing with a clear vision and shared values, they are making inroads into improving services. However, this is not happening everywhere, and there are examples of significant variation in the involvement of primary care providers. Primary care provider collaboratives that can stand side by side with other provider collaboratives for acute, community and mental health allow a route to system-level discussion across partners and cross-collaborative integration.
Spotlight: Derbyshire GP Board
The Derbyshire GP Board has received funding from the ICB to develop the primary care voice at system level. As a first priority, it led the development of a report on the ‘state of general practice’ which provided the ICS with a summary of how general practice operates in the area, how it is funded and what the key opportunities and challenges are for primary care. The GP board’s managing director stated this has helped to reduce misinformed decision-making and improve relationships with the ICS.
Offering resilience
The primary care system is facing increasing demand, workforce and estates pressures, leading to the need for new models of care. In response to these challenges, provider collaboratives can play a part in helping to create resilience and, where needed, reform. Both the Fuller stocktake and Hewitt review agreed that there needs to be support for new models that do not compete with the partnership model where it is working but offer a more mixed-model approach. This cannot be done to primary care: it needs to be done with the sector. These collaborations create the mechanism for primary care-led reform.
Spotlight: Herefordshire Provider Collaborative
Herefordshire Provider Collaborative (known as Herefordshire General Practice started out in 2012 as a GP federation known as Taurus Healthcare, which was owned by the then 24 practices in Herefordshire. The federation integrated with the local representative committee (LMC) and clinical directors to become one voice for general practice across Herefordshire.
The collaborative represents 20 practices, 200,000 patients, 300 employees and five primary care networks. Its executive board is made up of PCN clinical directors, federation leaders, ICS representatives and the LMC secretary.
This new operating model has successfully united representatives from across primary care to improve the delivery of 24/7 general practice, create greater resilience for practices, provide variety and development for our workforce and to amplify the voice of general practice in our local health and wellbeing system. As well as supporting general practice, the collaborative provides a range of at-scale primary care services include GP out-of-hours services, and has developed a strong analytics and business intelligence function able to monitor activity across all practices in Herefordshire and its impact on the wider system.
What needs to happen to enable these collaboratives to grow and develop?
National commitment
We support a locally led approach to developing provider collaboratives and know that overly-prescriptive national requirements do not achieve the best outcomes for local health and care systems. However, inequity in the requirements between trusts and primary care in developing collaboratives has created variation in how much primary care is involved in efforts to improve integration across different systems.
Collaboratives are a key component of system working, being one way in which providers work together to plan, deliver and transform services. There needs to be greater understanding, support and endorsement of the role of primary care in provider collaboratives. As detailed in our recent report, Supporting General Practice at Scale: fit for 2024/25 and beyond, NHS England should update national guidance on provider collaboratives to promote and encourage primary care involvement, where appropriate, as well as setting out its expectation of the role of primary care provider collaboratives.
Primary care provider collaboratives provide system-level infrastructure that allow local contracting but with accountability, ownership and leadership at all levels. This will be key to building a strong, locally driven approach to primary care service planning. Where this infrastructures exist, we are seeing more local commissioning arrangements informed by primary care responding to local need. In the long term, NHS England and the Department of Health and Social Care will want to encourage this by streamlining national contracts and increasing local incentive schemes, allowing systems to commission and design services based on local needs.
System legitimacy and support
For primary care provider collaboratives to have impact they need the legitimacy and support from system partners. Local discussions about how they operate as a key component within a complex system architecture, how they are resourced and how their development is supported, can help ensure they are as impactful as possible in helping to achieve systems’ four core purposes.
Leadership and membership with the right values
Moving from a group of individual organisations to building a true collaborative takes time and the right kind of leadership. Building a trusted relationship for collaboration needs to come long before any governance structure is developed. There is no one right approach to how these structures should be developed they need to be based on local factors and existing assets.
There is a process to getting from simply co-existing, or in some cases even competing, to collaborating. This requires strong leaders with willingness and determination to build shared purpose, collective responsibility and optimising the breadth of leadership capabilities required to build a strong collective (both managerial and clinical).
Support from the NHS Confederation
The NHS Confederation hosts the Provider Collaboration Forum and a space for existing and aspiring primary care provider collaborative leaders to share ideas, learn from one another and help raise awareness of the role and value of provider collaboratives. If you would like to join the forum, please contact primarycare@nhsconfed.org
During 2024/25, we will publish more detailed case studies and examples of primary care provider collaboratives across England. If you would like to showcase your work please email primarycare@nhsconfed.org
- With thanks to Dr Nicola Turner, GP and PCN clinical director at Chalfonts PCN, for her support with content and to our members for providing case studies.
