What is Risk Stratification?

You may notice a test result appear in your NHS App referring to Johns Hopkins Adjusted Clinical Groups.

To help us tailor care according to individual patient need, our practice uses a tool that groups patients into Patient Need Groups (PNGs). This system helps us understand overall health needs across our patient population so we can provide the right care at the right time.

The system was developed by Johns Hopkins University and is widely used internationally to support healthcare planning.

What Are Patient Need Groups (PNGs)?

Patient Need Groups categorise patients based on the complexity and intensity of their healthcare needs. Rather than focusing on a single condition, the system considers a broader picture of your overall health.

Patients are grouped into categories numbered 1 to 11:

Red – PNG 10–11: Complex Care Needs
Patients with multiple long-term conditions who may require regular monitoring and coordinated care.

Amber – PNG 5–9: Stable Chronic Conditions
Patients with long-term conditions that are generally well managed but may need occasional support.

Green – PNG 1–4: Lower Health Needs
Patients without significant ongoing health issues who may benefit from preventative care and routine monitoring.

* Your grouping may change over time as your health needs change.

Working with Sandhills PCN

We work alongside the Sandhills Primary Care Network (PCN) Risk Stratification Team to support this work.

The team includes:

• Kelly Houghton – PCN Manager
• Arti Patel – Clinical Director
• Dr Harvey Bhamra – GP
• Sarah Stringer – Clinical Coordinator
• Ashley Persaud – Digital & Transformation Lead

The team is initially focusing on patients within PNG 10 and PNG 11 to ensure those with the most complex needs receive proactive, coordinated support.

As part of this work, you may be contacted by Sandhills PCN. This is part of our efforts to better understand your needs and provide appropriate care.

If you would like further information or prefer not to be contacted as part of this work, please contact the practice.