'We're not there yet!': a qualitative study exploring the commissioning of adult Community Health Services in England to support the avoidance of hospital admissions.

Objectives: The increased use of Community Health Services (CHS) is central to UK policy visions of moving more care out of hospital to reduce pressure across the healthcare system and, in particular, the demand on secondary care, hospital services. CHS are under-researched, and little is known about how they can best contribute towards this aim. The National Health Service (NHS) in England has recently undergone a significant reorganisation, with an increased emphasis on collaborative service delivery.

Tackling health inequalities: What exactly do we mean? Evidence from health policy in England.

ObjectivesTo develop a model to support health systems in clarifying how they might target action to reduce health inequalities, and to use it to understand current policy on health inequalities in England.MethodsWe used the wider literature on the definitions of health inequalities to draw together a schematic model which attempts to link together the different conceptualisations of health inequalities present in the literature with potential sites of action that could be taken by local health systems. We then undertook a document analysis of the policy documents and programmes underlying the recent reorganisation of the NHS in England.

Employment and deployment of additional staff roles in general practice: a realist evaluation of what works for whom, how, and why.

Background: The Additional Roles Reimbursement Scheme (ARRS) was introduced in England in 2019 to alleviate workforce pressures in general practice by funding additional staff such as clinical pharmacists, paramedics, first-contact physiotherapists, and from 1 October 2024 the scheme funds recently qualified GPs. However, the employment and deployment models of ARRS staff present ongoing complexities and challenges that require further exploration.

Aim: To explore the decision-making processes behind primary care networks (PCNs) and general practice staffing choices, and how these choices influence the operationalisation of ARRS.

The hidden work of general practitioners: An ethnography.

High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it.

Investigating the impact of primary care networks on continuity of care in English general practice: Analysis of interviews with patients and clinicians from a mixed methods study.

Introduction: In England, primary care networks (PCNs) offer opportunities to improve access to and sustainability of general practice through collaboration between groups of practices to provide care with a broader range of practitioner roles. However, there are concerns that these changes may undermine continuity of care. Our study investigates what the organisational shift to PCNs means for continuity of care.

A paradox of problems in accessing general practice: a qualitative participatory case study.

Background: Despite longstanding problems of access to general practice, attempts to understand and address the issues do not adequately include perspectives of the people providing or using care, nor do they use established theories of access to understand complexity.

Aim: To understand problems of access to general practice from the multiple perspectives of service users and staff using an applied theory of access.

Design And Setting: A qualitative participatory case study in an area of northwest England.

Exploring whether primary care networks can contribute to the national goal of reducing health inequalities: a mixed-methods study.

Background: Significant health inequalities exist in England. Primary care networks (PCNs), comprised of GP practices, were introduced in England in 2019 with funding linked to membership. PCNs have been tasked with tackling health inequalities.

The patient experience of skill mix changes in primary care: an in-depth study of patient 'work' when accessing primary care.

Background: This paper presents insights into patient experiences of changes in workforce composition due to increasing deployment in general practice of practitioners from a number of different professional disciplines (skill mix). We explore these experiences via the concept of 'patient illness work'; how a patient's capacity for action is linked to the work arising from healthcare.

Methods: We conducted four focus group interviews with Patient Participation Group members across participating English general practitioner practices.

How new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study.

Background: There are inequalities in the geographical distribution of the primary care workforce in England. Primary care networks (PCNs), and the associated Additional Roles Reimbursement Scheme (ARRS) funding, have stimulated employment of new healthcare roles. However, it is not clear whether this will impact inequalities.

Consequences of the closure of general practices: a retrospective cross-sectional study.

Background: Two general practices close every week in the UK. Given the pressure on UK general practices, such closures are likely to persist. Yet little is known about the consequences.

Scale and spread of innovation in health and social care: Insights from the evaluation of the New Care Model/Vanguard programme in England.

Objective: Little is known about how to achieve scale and spread beyond the early local adoption of an innovative health care programme. We use the New Care Model - or 'Vanguard' - programme in the English National Health Service to illuminate the process, assessing why only one of five Vanguard programmes was successfully scaled up.

Methods: We interviewed a wide range of stakeholders involved in the Vanguard programme, including programme leads, provider organisations, and policymakers.

The effect of devolution on health: a generalised synthetic control analysis of Greater Manchester, England.

Background: The devolution of public services from central to local government can increase sensitivity to local population needs but might also reduce the expertise and resources available. Little evidence is available on the impact of devolution on population health. We evaluated the effect of devolution affecting health services and wider determinants of health on life expectancy in Greater Manchester, England.

Evaluation of the introduction of QOF quality improvement modules in English general practice: early findings from a rapid, qualitative exploration of implementation.

Background: A 2018 review of the English primary care pay-for-performance scheme, the Quality and Outcomes Framework, suggested that it should evolve to better support holistic, patient-centred care and leadership for quality improvement (QI). From 2019, as part of the vision of change, financially incentivised QI cycles (initially in prescribing safety and end-of-life care), were introduced into the scheme.

Objectives: To conduct a rapid evaluation of general practice staff attitudes, experiences and plans in relation to the implementation of the first two QI modules.

What makes a socially skilled leader? Findings from the implementation and operation of New Care Models (Vanguards) in England.

Purpose: The article aims to argue that the concept of "distributed leadership" lacks the specificity required to allow a full understanding of how change happens. The authors therefore utilise the "Strategic Action Field Framework" (SAF) (Moulton and Sandfort, 2017) as a more sensitive framework for understanding leadership in complex systems. The authors use the New Care Models (Vanguard) Programme as an exemplar.

Primary care workforce composition and population, professional, and system outcomes: a retrospective cross-sectional analysis.

Background: The diversification of types of staff delivering primary care may affect professional, population, and system outcomes.

Aim: To estimate associations between workforce composition and outcomes.

Design And Setting: Cross-sectional analysis of 6210 GP practices from a range of geographical settings across England in 2019.

Accessing primary care and the importance of 'human fit': a qualitative participatory case study.

Background: Good access to primary care is an important determinant of population health. While the academic literature on access to care emphasises its complexity, policies aimed at improving access to general practice in the UK have tended to focus on measurable aspects, such as timeliness or number of appointments.

Aim: To fill the gap between the complex understanding of primary care access in the literature and the narrow definition of access assumed in UK policies.

Integrated Care in England - what can we Learn from a Decade of National Pilot Programmes?

Introduction: For more than a decade the English NHS has pursued integrated care through three national pilot programmes. The independent evaluators of these programmes here identify several common themes that inform the development of integrated care.

Description: The three pilot programmes shared the aim of better coordination between hospital and community-based health services and between health and social care.