Primary care networks: A pre-mortem to identify potential risks

Primary care networks were introduced in early 2019 with the intention that they would stabilise general practice and act as the bedrock of integrated care systems. However, there is a lack of clarity over how broad national ambitions can be realised locally. What pitfalls face primary care networks as they become established, and how might they be avoided?

At the start of 2019, the NHS Long Term Plan introduced primary care networks (PCNs) as the building block of integrated care systems (ICSs). PCNs are intended to cover 30-50,000 registered patients, and NHS England has produced a set of ambitions for these new bodies. However, while these ambitions provide a sense of direction for PCNs, further clarity at local levels about what the ambitions mean and how they can be realised is important for PCNs to avoid failure. Yet at this stage there is no indication that formal national guidance will be issued to direct local activity. 

To help the system anticipate the risks and challenges PCNs are likely to face in the next five years, the Nuffield Trust and event partners drew together 45 GPs, local commissioners and representatives from NHS England/Improvement and the British Medical Association to undertake a ‘pre-mortem’ exercise to consider the threats and weaknesses of the introduction of PCNs by imagining their hypothetical failure. 

This working paper presents six risks that could lead to the failure of PCNs: 

  • Failure could be inherent in the policy design 
  • PCNs may not be able to create effective organisations 
  • PCNs could have a lack of focus 
  • PCNs could experience failures of leadership and followership 
  • PCNs could become overwhelmed by external pressure 
  • Failure could be unfairly identified too early 

We suggest a set of recommendations and possible solutions for avoiding each of these pitfalls. 


Appears in

  • 13/12/2021
  • Sarah Scobie