The 2014 Better Health for London report did not simply ask GPs to work harder inside their own four walls. One of its central prescriptions was structural: general practices needed to stop operating as small, isolated units and start working in networks or federations, pooling staff and services to widen access and shift more care out of hospitals. A decade later, that recommendation has a direct organisational descendant — the primary care network — and the evidence on how it has actually performed in London is more layered than a simple delivered-or-stalled verdict allows.
What the 2014 Report Actually Called For
The Commission’s brief on primary care was not abstract. It argued that London’s fragmented, practice-by-practice model of general practice was a structural barrier to the kind of convenient, broad-ranging out-of-hospital care the report wanted to see. Grouping GPs into larger federations, it argued, would let practices share staff, extend the range of services on offer, and offer more flexible appointment times than any single small partnership could manage alone. This sat alongside the report’s wider theme that too much care in London was still being delivered in hospitals when it could safely happen closer to home.
From Federations to a National Blueprint
That call for GP collaboration foreshadowed a policy that arrived five years later: NHS England’s primary care networks, introduced as a core component of the NHS Long Term Plan in 2019. Where the report spoke in general terms about federations, PCNs gave the idea a formal structure — geographically defined groupings of GP practices, typically covering tens of thousands of patients, with dedicated funding streams and a contractual requirement to collaborate. The concept of GP federations that had already begun emerging around 2014 shared the same underlying purpose: cooperation among providers to achieve economies of scale and deliver a wider service offer than any single practice could sustain.
How Far the Model Actually Reached
On pure coverage, the collaboration model the report envisioned has arrived almost everywhere. A decade after the report, primary care networks are near-universal, with over 99% of general practices across England, including London, now part of one. That is a scale of structural change few of the report’s other recommendations achieved. The practical expression of that structure has been the Additional Roles Reimbursement Scheme, which let networks recruit patient-facing staff beyond the traditional GP and practice nurse model — social prescribing link workers, mental health practitioners, physiotherapists and others — widening the range of services a patient can access without a hospital referral, much as the 2014 report envisaged. PCNs themselves are structured to focus on delivering that expanded service offer, while the planning and funding decisions behind it sit one level up, with Integrated Care Boards.
Where London’s Version Diverges
Universal coverage is not the same as a clean fit with the report’s ambition, and the London-specific evidence points to a genuine mismatch. Primary care networks were built around population size, not around the borough and neighbourhood boundaries that London’s councils and Integrated Care Boards use to plan community health services. Many London networks instead reflect the historic patterns of which practices already worked together and where patients chose to register, in a uniquely dense and mobile city, rather than tidy geographic contiguity. That mismatch matters in practice: it complicates the alignment between a network and the wider neighbourhood health teams London boroughs are trying to build, and there are documented concerns that larger-scale, multi-practice care has come at some cost to continuity — patients seeing a less familiar mix of clinicians and navigating processes that are more coordinated for the most vulnerable but can feel more cumbersome for everyone else.
| 2014 Report Recommendation | What the PCN Model Delivered | Ten-Year Status |
|---|---|---|
| Group GPs into federations/networks | Primary care networks under the 2019 NHS Long Term Plan | Near-universal: over 99% of practices covered |
| Widen the range of services on offer | Additional Roles Reimbursement Scheme staff (link workers, physios, mental health roles) | Rolled out, still maturing |
| More convenient, flexible access | Shared appointment capacity across grouped practices | Uneven, variable by network |
| Coherent local groupings | Network boundaries based on patient list size | Mismatched with London borough/ICB boundaries |
What the Funding Trajectory Signals Next
The organisational story is also not static. Even as the network model became embedded, its funding and remit have kept shifting: a meaningful share of general practice funding is now channelled through PCN mechanisms, and the network focus has been drifting toward the broader neighbourhood-health and integrated-care-system agenda rather than sitting still as the fixed structure the 2014 report imagined. The direction of the most recent GP contract changes has, if anything, been to trim the scope and funding running through networks and push resource back to individual practices — a reminder that the federation model the Commission called for was never going to be a one-off fix, but an organisational experiment London’s general practice is still adjusting a decade on.
The Honest Read a Decade On
Judged purely against the report’s ask — get GPs collaborating in networks that widen access and services — the structural piece has clearly landed: almost no London practice now operates in isolation. Judged against the deeper goal behind that recommendation, a genuinely coherent, locally rooted model of out-of-hospital care, the picture is more mixed. Coverage came fast; coherence with London’s own geography, and consistency of the patient experience inside these larger groupings, are still catching up. That gap between structural delivery and practical fit is a recurring theme across many of the 2014 report’s recommendations, and primary care networks are one of the clearest examples of it.