It has come to my attention, that we are now facing a pressing issue with one primary care network (PCN) Doctor's surgery holding an overwhelming dominance over healthcare services in our local area.

There have been several serious complaints against Doctors from this surgery over the last few years - 1 in particular.  Yet, now the Doctor resides on the PCN board (hidden from public view), along with others from the same surgery.

The policies/politics by this particular board member are not in patient interests' within GP.

The DANGERS of monopolisation -

• The dominant surgery secures the clinical director role, aligning network priorities with their own practice goals (this will affect patient complaints/outcomes and will naturally result in conflicts of interests).
• The largest practice holds more voting weight
• Misconduct can go undetected/unreported
• Management and HR functions get clustered in the main surgery
• The dominant surgery controls key decisions, resource allocation, and funding streams.  This imbalance sidelines smaller practices, reduces collaborative decision making and centralizes power, leading to friction and inequitable patient service distribution across the network.

Our local healthcare system should serve the diverse and growing needs of its community. However, when a single surgery dominates, this can lead to reduced competition, complacency, and an adverse impact on patient care.

It is essential for other surgeries within this network to have an equal share of resources and patients, to break barriers to entry; show innovation; ensuring that all voices are represented, and all needs are adequately addressed.

Lack of diversity in healthcare providers often results in longer wait times, rushed appointments, and sometimes even difficulty in accessing a preferred GP. These issues are not just administrative inconveniences—they can endanger patient health and wellbeing. Numerous studies highlight the importance of equitable healthcare distribution in improving patient outcomes and satisfaction.

We urge and encourage local commissioning oversight (ICB), and Healthwatch to thoroughly scrutinise the operations of the dominating PCN surgery. This involves ensuring equitable distribution of resources and opportunities across all surgeries in the area, promoting fair recruitment and support for underrepresented practices, and implementing transparent policies regarding patient allocations.

Your support can drive change in the healthcare system, ensuring that everyone receives the quality care they deserve. 

As a patient/member of public, you can also help.

• Join your PPG in your surgery: question during meetings how network wide services are distributed.  Ask how the PCN's shared staff (pharmacists, mental health practioners) are being split between your surgery and the dominant one.

This will help your practice managers to acknowledge the issue and gives the surgery patient backing, to fight for their fair share at the next PCN meeting.

• Contact the ICB: report to the commissioning team to report unequal service access and highlight monopolisation, which is affecting your practice.  
• Contact Healthwatch: report the imbalance to your local Healthwatch to trigger an independent review of patient equity.
• Seek Independent Advocacy

This dominance not only affects the quality and accessibility of medical care but also leaves many residents feeling that their voices are not heard, and their needs are not met.

You can make a difference!  Help yourself, other patients and your GP surgery within your local area.  Please sign and share.