Primary care networks (PCNs) are a major change intended to improve primary care services for patients.
But are those responsible for establishing each PCN actually talking to patients about how it is being designed and will operate?
As chairman of a patient participation group (PPG), I try to follow developments in primary care. I think the role of a PPG is to be a critical friend, to support the
surgery and to be a conduit for patient opinion. But PPGs can be hampered in doing this if CCGs, GPs and practice managers don’t keep us informed about significant things that are going on and don’t give us a voice. The introduction of PCNs is a prime case in point.
From my own experience and soundings elsewhere, the public have often been told very little about PCNs and involved even less, although I recognise there may be honourable exceptions I’m not aware of.
On the one hand, it’s only three months since the Long Term Plan was published and guidance (none of which I’ve seen) is still being drip-fed to CCGs and practices. I guess therefore it’s no surprise that commissioners, GPs and practice managers have been focusing almost exclusively on business models, relationships between surgeries, visions and priorities in the push towards registration on 15th May.
On the other hand, Refreshing NHS Plans for 2018/19 said 14 months ago that PCNs were a deliverable for 2018/19. And even in the rush since January, patients ought to have been informed of what’s going on and consulted on PCN boundaries.
But more importantly now, what about after mid-May? How are patients and the public going to be involved in establishing and managing PCNs in future? Will patients be brought in to discuss the design and implementation at the local level? Will PCNs practice co-production?
Public involvement shouldn’t be a niceto-have add-on or a token gesture. We, the patients, are the ones who are going to be affected by any changes locally. For every patient, their GP is the critical entry point to the whole health service and also for many social care services. We want to know what is happening and have a say.
Aside from this moral imperative, the legal requirements to involve patients and the 2015 NHS England participation policy, there are practical benefits from involving patients.
First, we won’t feel bounced into unexpected change. Public participation will provide the opportunity to get community buy-in and trust and build PCN reputation, rather than, for example, our patients’ group currently being anxious about impacts on those with long-term conditions seeing their regular GP – which may or may not be an unfounded concern.
Second, health professionals don’t have a monopoly of wisdom on what is best for patients and what the patient perspective is. Take a decision on which practices should group together to form a PCN or which practice should host the social prescriber. These decisions could have significant implication for patient journeys.
Public transport routes, particularly in rural areas, might favour different arrangements to those which might seem obvious to GPs and practice managers.
Third, PCNs can tap into a wealth of local expertise and knowledge by collaborating with patients during the design and implementation of the new PCNs rather than simply presenting a fait accompli. From discussions I’ve had, I think there are probably four main reasons why engagement is not happening:
- No time: I hope most patients realise and sympathise with the pressures on primary care staff
- Culture: I guess historically primary care professionals have adopted more of a top-down, rather than a consultative approach, and practices are of course also businesses
- Fear: a sense that engagement is tantamount to volunteering to be in the firing line for time-consuming brickbats
- Incomprehension: what on earth are the benefits?
All of these are understandable. But in the same way that the direction of travel is towards patient-centred care and recognising patients have both rights and responsibilities, it is important that patients are given the chance to have their say and play a part in how services are set up and run. With constructive engagement, the benefits may well at least match the time and effort spent, so that there is no net burden.
And don’t forget the NHS constitution: “The patient will be at the heart of everything the NHS does”.
I don’t envy the challenge PCNs present to the dwindling number of GPs, who also face many other pressures. But pressing ahead with PCNs without enabling active participation from patients is both wrong and potentially counterproductive.
Mike Etkind has been chair of his surgery’s patient participation group for the last three years.
Last Updated on 3 May 2023
