A laymen’s observations of a PCN

Congratulations, you have managed to navigate through the NHS three-letter acronyms to this document describing another three-letter acronym, the PCN! But first a little history!

As you may know back in the mists of time, every medical Practice in the UK was encouraged (financially) to set up a Patient Participation Group (PPG). This was designed to give patients the opportunity to meet together and discuss any issues relating to their care. As well as to discuss other matters that should be of concern to the Practice. This arrangement enabled patients to give improvement feedback to the Practice Manager, the staff and the Doctors . The PPGs have always been for many years, a valuable and democratic Patients voice. Many Practices have come to rely on the willing members of their PPG to help in practical ways with the administration of the Surgeries. This has been mutually beneficial to all parties. However, for their own reasons, some Practices chose not to support or encourage the patients to form such a group, a detriment to both the Practice, who did not have support of volunteered help, and the patient voice for an outlet for any concerns.

Representatives of the PPGs would attend locality groups known as Patient Locality Networks (PLN) to raise issues that could then be taken forward to the Patient Network Quality (PNQ). This was a sub-committee of the main quality board. Two members of the PNQ were also members of the main board. Issues raised at a PPG meeting could arrive as an agenda item of the main Clinical Commissioning Group (CCG) via the PLN and the PNQ. Unfortunately, this structure was lost in the later ICB set up, hence there was no obvious method to bring issues to the board for consideration and correction.

Part of the underlying purpose of the new Patient Engagement Platform (PEP) is to encourage every Practice to support and expand their PPG network. We have a list of all the Practices and have over the last couple of years tried to identify which individuals are involved with each PPG. In East and North Herts, there are 47 practices and in South and West Herts I believe there are 48. We do not at this stage have any understanding on the wider Central & East Integrated Care Board (CEICB).

And so to the rise in PCN’s

A few years ago, just before Covid, the Government decided that they would create clusters of local Practices to form groupings of approximately 50,000 patients. The idea was to enable a grouping of that size the ability to ‘buy in’ expertise within the group. Therefore, it may not be necessary to send a patient to secondary care (Hospital or specialist treatment area’s) for some minor issue, but to treat them locally. Problems such as Physiotherapy or the like, could be treated in house for quicker turn-round and giving more local control. In addition, services such as Pharmacists for drug management, Phlebotomy, and other support services like Social prescribing, are able to give none-medical help and advice. Eventually, mental health issues could also be addressed within the group of Surgeries.

In some PCN’s, like my own, the PPG’s want to do more. We wanted to offer our combined efforts to support the cluster as a whole. At an early stage, we grouped together and offered the PCN managers a marshalling service for Covid clinics that were being run every week. We helped with parking in the public car parks, directing patients to empty spaces and help the infirm patients to cross busy roads. We asked the patients the mandatory questions required for eligibility, we kept the queues spaced and in order, ensuring the swift and efficient inoculations whenever the service was being offered. As a result of all these efforts, backlogs and delays were kept to a minimum, all of which consolidated our relationships with the surgery staff.

When the majority of Covid treatments were passed, the four Practice PPG leads held regular meetings with the PCN management to offer other help. As a result, we set up a series of presentations to all patients of the cluster who would benefit from advice on specific aspects of health. The first presentation was on Diabetes, and invitations were sent by text from the Practices to the patients filtered from their databases, these were selected as those who would benefit from support with their Diabetic management.

The presentations were held in a local hall in an evening and the speakers consisted generally of a senior doctor or specialist in the condition, a nurse practitioner involved in its treatment and management and often a patient with lived experience. This proved to be very successful with very good attendance, particularly from the male patients. This first experiment was followed with a talk regarding Bowel Screening. One of the benefits of this approach was that it gave the patients a chance to ask a question in the open forum, or privately with the specialist during the tea-break or after the end of the event. It was clear the attendees found this approach very informative.

After the success of the first year, we planned five presentations in 2024. These covered issues such as Mental illness, Parkinson’s, Dementia, ADHD and finally Prostate Cancer, where the now five strong Practice PCN, filled the hall with over 100 predominantly male patients. In both 2025 and 2026, five further events have or will be organised.

In recognition of our efforts with these presentations., the Herts and West Essex ICB presented the PCN with An Excellence in Patient Engagements Award in 2024. This was an award for the PPGs, the Practice Staff and the PCN management. The overall outcome has benefited very many patients with their health challenges.

This clearly demonstrates the power of the Patient Voice

Observations by RGW