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HIN CoPs created enthusiastic engagement and provided their members with an attractive route to greater patient safety and healthcare improvement.

If the knowledge needed to address the problem is contained within, or can be explored through, the CoP, there is an opportunity to deliver change. However, if the knowledge is not accessible to the community, and if the levers for delivering change are beyond its reach, there needs to be some modification of the model to engage senior leadership, change national mandates or work with commissioners.

Based on our research, we proposed a five-level maturity model for the HIN CoPs. Sustaining the rhythm of learning at a high level of maturity may be more easily done where the CoP is linked to, or embedded within, other approaches to improvement.

This report identified a number of future evaluation questions along with associated subsidiary questions. The key overarching questions are:

• (How) is the momentum towards transformation sustained and what are the wider dependencies that are needed for this to happen?
• (How) is progress and value-added measured?
• (How) is the rhythm of learning sustained?
• (How) are cultures and principles nurtured and sustained?