TY - JOUR
AU - J. Elston
AU - F. Gradinger
AU - T. Bockarie
AU - K. Tomblin
AU - G. Snaith
AU - R. Byng
AU - S. Asthana
A1 - 
AB - INTRODUCTION: Population Health Management (PHM) is a UK priority for Integrated Care Systems (ICSs), aiming to deliver proactive, preventative, person-centred care using integrated health and care datasets. However, evidence on implementation in primary care remains limited. METHODS: This comparative case study used embedded researchers, ethnography, interviews, and observations to formatively evaluate a 24-month PHM programme across 31 Primary Care Networks in one ICS. Data were thematically analysed using Excel and NVivo, with findings fed back to participants to guide programme delivery. RESULTS: Around 200 stakeholders participated in Action Learning Sets, fostering cross-sector collaboration within four localities. Few innovations, developed using integrated datasets, progressed to delivery, limiting their impact on patient health. While PHM infrastructure was established, delivery was constrained by operational pressures, data governance challenges, limited resources, lack of strategic integration and the nature of local relationships. DISCUSSION: Effective PHM implementation requires more than infrastructure and governance. It depends on developing system-wide soft skills (facilitation, co-production), motivating stakeholders, and investing in processes that support insight generation, innovation piloting, and evidencing of impact. CONCLUSION: The study highlights the need for stronger strategic integration, sustained resourcing, coordination, and co-production to realise PHM's potential at system, place and neighbourhood levels in addressing health inequalities and improving population outcomes.
AD - Community and Primary Care Research Centre, University of Plymouth, United Kingdom.; Plymouth Health Determinants Research Collaboration, United Kingdom.; Honorary Global Health Researcher, King's College London, United Kingdom.; Devon County Council, United Kingdom.; NHS Devon Integrated Care Board, United Kingdom.; Centre for Health Technology, University of Plymouth, United Kingdom.; Centre for Coastal Communities, University of Plymouth, United Kingdom.
AN - 42040046
BT - Int J Integr Care
C5 - Education & Workforce
CP - 2
DA - 12/1969
DO - 10.5334/ijic.10027
DP - NLM
ET - 20260424
IS - 2
JF - Int J Integr Care
LA - eng
N2 - INTRODUCTION: Population Health Management (PHM) is a UK priority for Integrated Care Systems (ICSs), aiming to deliver proactive, preventative, person-centred care using integrated health and care datasets. However, evidence on implementation in primary care remains limited. METHODS: This comparative case study used embedded researchers, ethnography, interviews, and observations to formatively evaluate a 24-month PHM programme across 31 Primary Care Networks in one ICS. Data were thematically analysed using Excel and NVivo, with findings fed back to participants to guide programme delivery. RESULTS: Around 200 stakeholders participated in Action Learning Sets, fostering cross-sector collaboration within four localities. Few innovations, developed using integrated datasets, progressed to delivery, limiting their impact on patient health. While PHM infrastructure was established, delivery was constrained by operational pressures, data governance challenges, limited resources, lack of strategic integration and the nature of local relationships. DISCUSSION: Effective PHM implementation requires more than infrastructure and governance. It depends on developing system-wide soft skills (facilitation, co-production), motivating stakeholders, and investing in processes that support insight generation, innovation piloting, and evidencing of impact. CONCLUSION: The study highlights the need for stronger strategic integration, sustained resourcing, coordination, and co-production to realise PHM's potential at system, place and neighbourhood levels in addressing health inequalities and improving population outcomes.
PY - 2026
SN - 1568-4156 (Print)
SP - 5
ST - Implementing Population Health Management (PHM) Across an Integrated Care System in England, Using Action Learning Sets and an Embedded, Formative Process Evaluation
T1 - Implementing Population Health Management (PHM) Across an Integrated Care System in England, Using Action Learning Sets and an Embedded, Formative Process Evaluation
T2 - Int J Integr Care
TI - Implementing Population Health Management (PHM) Across an Integrated Care System in England, Using Action Learning Sets and an Embedded, Formative Process Evaluation
U1 - Education & Workforce
U3 - 10.5334/ijic.10027
VL - 26
VO - 1568-4156 (Print)
Y1 - 2026
ER -