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BackgroundThere 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, has stimulated employment of new healthcare roles. However, it is not clear whether this will impact inequalities. AimTo examine whether the ARRS impacted inequality in the distribution of primary care workforce.Design and SettingA retrospective before-and-after study of English PCNs in 2019 and 2022MethodsWe combined workforce, population and deprivation data at network-level for March 2019 and March 2022. We estimated the change between 2019 and 2022 in the Slope Index of Inequality (SII) across deprivation of full-time equivalent general practitioners (total doctors, qualified GPs and doctors-in-training), nurses, other direct patient care (ARRS and non-ARRS staff), administrative, and total staff per 10,000 patients.Results1255 networks were included. Nurses and qualified GPs decreased in number whilst all other staff roles increased, with ARRS staff having the greatest increase. There was a pro-rich change in the SII for administrative staff (-0.482 (95% CI: -0.841, -0.122)) and a pro-poor change for doctors-in-training (0.161 (0.049, 0.274)). Changes in distribution of all other staff types were not statistically significant. ConclusionThe distribution of administrative staff became less pro-poor and of doctors-in-training became pro-poor between 2019 and 2022. The changes in inequality in all other staff groups were mixed. The introduction of PCNs has not substantially changed the longstanding inequalities in the geographical distribution of primary care workforce.

Supplemental material, sj-pdf-1-hsr-10.1177_13558196211059128 for Unseen patterns of preventable emergency care: Emergency department visits for ambulatory care sensitive conditions by Beth Parkinson, Rachel Meacock, Katherine Checkland and Matt Sutton in Journal of Health Services Research & Policy

Supplemental material, sj-pdf-5-hsr-10.1177_13558196211059128 for Unseen patterns of preventable emergency care: Emergency department visits for ambulatory care sensitive conditions by Beth Parkinson, Rachel Meacock, Katherine Checkland and Matt Sutton in Journal of Health Services Research & Policy

Supplemental material, sj-pdf-3-hsr-10.1177_13558196211059128 for Unseen patterns of preventable emergency care: Emergency department visits for ambulatory care sensitive conditions by Beth Parkinson, Rachel Meacock, Katherine Checkland and Matt Sutton in Journal of Health Services Research & Policy

Supplemental material, sj-pdf-2-hsr-10.1177_13558196211059128 for Unseen patterns of preventable emergency care: Emergency department visits for ambulatory care sensitive conditions by Beth Parkinson, Rachel Meacock, Katherine Checkland and Matt Sutton in Journal of Health Services Research & Policy

Supplemental material, sj-pdf-6-hsr-10.1177_13558196211059128 for Unseen patterns of preventable emergency care: Emergency department visits for ambulatory care sensitive conditions by Beth Parkinson, Rachel Meacock, Katherine Checkland and Matt Sutton in Journal of Health Services Research & Policy

Supplemental material, sj-pdf-4-hsr-10.1177_13558196211059128 for Unseen patterns of preventable emergency care: Emergency department visits for ambulatory care sensitive conditions by Beth Parkinson, Rachel Meacock, Katherine Checkland and Matt Sutton in Journal of Health Services Research & Policy

Supplemental Material for General practice managers’ motivations for skill mix change in primary care: Results from a cross-sectional survey in England by Jon Gibson, Anne McBride, Katherine Checkland, Mhorag Goff, Mark Hann, Damian Hodgson, Imelda McDermott, Matt Sutton and Sharon Spooner in Journal of Health Services Research & Policy

Pilot projects are increasingly used as a mechanism to enact organizational change, particularly government policy. Information technology’s centrality to organizations often makes it key to the introduction of new processes. However, it can give rise to workarounds as employees circumvent impediments it presents by rejecting its prescribed use. Workarounds tend to be conceptualised dichotomously, as either ‘good’ problem solving, or ‘bad’ subversion of the technology. In pilot projects, workarounds are more ambiguous because those that support projects’ successfulcompletion in the short-term may undermine day to day operations longer term. We draw on interview data from a policy pilot in general practice in the National Health Service in England aimed at extending access to care. We problematize the dichotomous conceptualisation of workarounds, finding they can be simultaneously supportive and undermining of policy pilots. Workarounds thereby become political, as employees are required to trade-off consequences for themselves and the wider organization.

Additional file 1: Table S1. List of Clinical Commissioning Groups participating in the Pioneer (63) and Vanguard (35) integration programmes. Figure S1. Location of Clinical Commissioning Groups participating in the Pioneer and/or Vanguard programmes.

Background: General practices in England have been encouraged by national policy to work together at a larger scale by creating Primary Care Networks. Policy guidance recommended they should serve populations of 30,000-50,000 people to perform effectively.Aim: To describe variation in the size and characteristics of Primary Care Networks and their populations.Design and Setting: Cross-sectional analysis in England. Method: Using published information from January 2020, we identified Networks that contained fewer than 30,000, between 30,000 and 50,000, and more than 50,000 people. We calculated percentiles to describe variation in size and population characteristics. We also examined Network composition within each commissioning region.Results: 6,758 practices had formed 1,250 Networks. 726 (58%) Networks had therecommended population of 30,000 to 50,000 people. 84 (7%) Networks contained fewer than 30,000 people. 440 (35%) Networks contained more than 50,000 people. 34 Networks comprised just one practice and 77 Networks contained more than 10 practices. Some Networks contained over double the proportions of older people and people with chronic conditions compared to others. More than half of the population were from very socioeconomically deprived areas in 172 (14%) Networks. All Networks were in the recommended population range in only 6 (4%) of the 135 commissioning regions. All practices had joined a single Network in 3 (2%) commissioning regions.Conclusion: More than 40% of Primary Care Networks were not of recommended size and there was substantial variation in their composition and characteristics. This high variability between Networks is a risk to their future performance

Background For the last few years, English general practices, which are traditionally small, have been encouraged to work together to serve larger populations of registered patients, by merging or collaborating with each other. Meanwhile, patient surveys suggest worsening continuity of care and access to careAim To explore whether increasing size of practice population and working collaboratively are linked to changes in continuity of care or access to care Design and setting Observational study in English general practice using data on patient experience, practice size and collaborative workingMethods The main outcome measures were General Practice Patient Survey practice-level proportions of patients reporting positive experiences of access and relationship continuity of care. We compared change in proportions 2013-2018 among practices that had grown and those that had stayed about the same size. We also compared patients’ experiences by whether practices were working in close collaborations or not in 2018.Results. Practices that had grown in population size had a greater fall in continuity, by 6.6% (95% confidence interval 4.3% to 8.9%) than practices that had stayed about the same size, after controlling for other factors. There was no similar difference in relation to access to care. Practices collaborating closely with others had marginally worse continuity of care than those not working in collaboration and no important differences in access.Conclusion Concerns that larger general practice size threatens continuity of care may be justified.

COVID-19 has thrown NHS procurement into the limelight, but the shortage of personal protective equipment (PPE) has complex origins. This article explores the long-lasting struggle for centralisation in NHS procurement and its impact on the current PPE crisis.

In the context of tightening budgets, organisational complexity, and the urgency of addressing the staggering inequalities of access and outcomes across the country, this is a time of unprecedented challenge for our health and care services.Primary care is the public face of the NHS; the first point of contact for millions of men, women and children across the UK every day. It has become increasingly clear that, in order to cope with the invidious combination of rising demand and limited resources, it is essential to improve the quality, efficiency and effectiveness of these vital services.The key for policymakers to achieve this, is integration. That is why I am pleased to introduce this new publication from Policy@Manchester, which sets out to address some of the biggest challenges of integration now facing the primary care sector.This collection draws upon the formidable depth of expertise within The University of Manchester’s Faculty of Biology, Medicine and Health, with contributions from researchers affiliated with the recently-formed Institute for Health Policy and Organisation, the Centre for Pharmacy Workforce Studies, and the Alliance Manchester Business School.This work is timely. The conversion of sustainability and transformation partnerships into integrated care systems is still underway, the primary care networks initiative still less than one year old, and the new contract framework for pharmacy was agreed only last year. On Primary Care delivers fresh and critical insight into the changes that are now taking place in our family surgeries, high street chemists, and clinics.The articles contained within this volume, and the expertise of its authors, will be of great value to anyone involved in the creation, implementation, or scrutinyof primary care policy and practice.I hope that each of these pieces, and On Primary Care as a whole, will make a full and substantive contribution to the ongoing development of the primary care sector, and improving the health andcare services on which we all, ultimately, rely.