How primary care networks can help integrate academic and service initiatives in primary care.
OBJECTIVE
Theory of effective network operation in primary care is underdeveloped. This study aimed to identify how primary care networks can best integrate academic and service initiatives.


METHODS
We performed a comparative case study of 4 primary care research networks in North London, England, for the years 1998-2002. Indicators were selected to assess changes in (1) research capacity, (2) multidisciplinary collaboration, and (3) research productivity. We compared the profiles of network outcome with descriptions of their contexts and organizational types from a previous evaluation.


RESULTS
Together, the networks supported 133 viable projects and 30 others; 399 practitioners, managers, and academics participated in the research teams. How the networks organized themselves was influenced by the circumstances in which they were formed. Different ways of organizing were associated with different outcome profiles. Shared projects and learning spaces helped participants to develop trusted relationships. A top-down, hierarchical approach based on institutional alliances and academic expertise attracted more funding and appeared to be stable. The bottom-up, individualistic network with research practices was good at reflecting on practical primary care concerns. Whole-system methods brought together stakeholder contributions from all parts of the system.


CONCLUSIONS
Networks can help integrate academic research and service development initiatives by facilitating interorganizational interactions and in shared leadership of projects. Researchers and practitioners stand to gain considerably from an integrated approach in both the short and the long term. Success requires agreement about a set of pathways, learning spaces, and feedback mechanisms to harness the insights and efforts of stakeholders throughout the whole system.
Thomas
Paul
P
Centre for Study of Policy and Practice in Health and Social Care, Thames Valley University, Westel House, London, England. Paul.Thomas@tvu.ac.uk
Graffy
Jonathan
J
Wallace
Paul
P
Kirby
Mike
M
D019058:Community Networks / Q000458:organization & administration*; D003695:Delivery of Health Care; D004501:Education, Medical; D004739:England; D006801:Humans; D019982:Organizational Case Studies; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care