Legal structures are not a good place to start when thinking about collaboration, according to a leading lawyer at the NHS Confederation conference in Manchester on Wednesday. Peter Edwards, a partner at Capsticks, told a panel convened by the National Association of Primary Care: “Form should follow function. The start point has to be the principles for the work. There are lots of good models around, but I don't think the first step is a vehicle to employ staff.”

Mr Edwards suggested that a top down approach could be beneficial in resolving the tax – and particularly VAT – issues that the emerging primary care networks would need to work through in the new contracting models.

Collaboration needs to start with front line champions,” said Professor Matthew Cripps, NHS England director of sustainable healthcare. “Every single best example we have seen has started with this. System leaders then get on board.”

“The burning platform forces relationships,” said Peter Aitken, r&d director at Devon Partnership NHS Trust. “It’s a fantastic driver to talk about how we can improve things together.”

Dr Caroline Taylor, North Halifax Community Wellbeing Partnership, suggested engaging with a wide range of stakeholders. “Our first collaborative meeting included social care, the acute trust, the mental health trust, the voluntary sector, housing, social prescribing. Invite anybody who's interested,” she said.

“People from small organisations should feel as important as the largest; that's important. We have a team that feels like a team,” Dr Taylor said. “Asking everyone what they think is important, but so is asking people what they need. Go where the evidence suggests, but it’s more important that wider collaborative groups do something that people agree on.”

Dr Nav Chana, NAPC joint national clinical director, asked how PCNs should manage the challenge of the contract model pushing everything through GP practices. Dr Taylor agreed that it was “horrifying to see people want to narrow things back to GPs”.

In Halifax they are working this through with two boards, one looking at the GP direct enhanced services contract, the other continuing the work to date on the longer-term integrated vision, Dr Taylor said, adding: “We are looking to merge the two over time; it’s vital to the focus on the long-term vision while working through short term contractual focus on GPs."

Matthew Winn, director of community health at NHS England, suggested it is important to start with what you want to achieve. “It doesn’t matter who employs people, as long as they are good employers. Don't go down the route of GP employers if they are not good at it or not interested in it. It would be bad if all primary care networks think they need to become mini-employers,” he said.

When asked what fostered leadership in the new system, Dr Aitken responded: “Trust, transparency, time together." Dr Taylor agreed, adding “time to get outside our existing boxes.” Professor Cripps said the leaders of the new PCNs would need to be "brave" to cede control to advance other clinicians.