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Clinical networks are effective, work in patients’ interests, and shouldn’t be disbanded

BMJ 2013; 346 doi: (Published 28 January 2013) Cite this as: BMJ 2013;346:f565
  1. Roger Boyle, director, National Centre for Cardiovascular Prevention and Outcomes, University College London and former national director for Heart Disease and Stroke
  1. roger.boyle5{at}

Clinical networks are an established part of National Health Service infrastructure. Over the past decade they have operated in specialist areas throughout the NHS in England and, in a different shape, in Scotland and Wales. They vary in form and function, from groups of interested clinicians who meet occasionally to more formal, managed clinical networks established for major conditions such as heart disease, cancer, and stroke.

These more formal networks bring coherence to clinical services for populations of 1.5-2 million, help centralise services, and try to standardise cost effective clinical pathways of care among institutions. They counterbalance the power of individual hospitals, which tend to try to retain business at the expense of optimal service configuration. The networks also provided a focus for local clinical leadership as national policies for major killing conditions were being implemented. The national service framework for coronary heart disease and the national stroke strategy were not conceived and delivered in Whitehall but drew from, and were delivered by, the grass roots of the NHS. The networks became part of a movement that developed and maintained service improvement. In time, this service improvement element was formalised under the umbrella of NHS Improvement, so that new learning as well as proved ideas …

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