Identifying naturally occurring communities of primary care providers in the English National Health Service in London

OBJECTIVES: Primary Care Networks (PCNs) are a new organisational hierarchy with wide-ranging responsibilities introduced in the National Health Service (NHS) Long Term Plan. The vision is that PCNs should represent ‘natural’ communities of general practices (GP practices) collaborating at scale and covering a geography that fits well with practices, other healthcare providers and local communities. Our study aims to identify natural communities of GP practices based on patient registration patterns using Markov Multiscale Community Detection, an unsupervised network-based clustering technique to create catchments for these communities. DESIGN: Retrospective observational study using Hospital Episode Statistics - patient-level administrative records of attendances to hospital. SETTING: General practices in the 32 Clinical Commissioning Groups of Greater London PARTICIPANTS: All adult patients resident in and registered to a GP practice in Greater London that had one or more outpatient encounters at NHS hospitals between 1(st) April 2017 and 31(st) March 2018. MAIN OUTCOME MEASURES: The allocation of GP practices in Greater London to PCNs based on the registrations of patients resident in each Lower Layer Super Output Area (LSOA) of Greater London. The population size and coverage of each proposed PCN. RESULTS: 3 428 322 unique patients attended 1334 GPs in 4835 LSOAs in Greater London. Our model grouped 1291 GPs (96.8%) and 4721 LSOAs (97.6%) into 165 mutually exclusive PCNs. Median PCN list size was 53 490, with a lower quartile of 38 079 patients and an upper quartile of 72 982 patients. A median of 70.1% of patients attended a GP within their allocated PCN, ranging from 44.6% to 91.4%. CONCLUSIONS: With PCNs expected to take a role in population health management and with community providers expected to reconfigure around them, it is vital to recognise how PCNs represent their communities. Our method may be used by policymakers to understand the populations and geography shared between networks.