Would you like, say, air conditioning installed free in your patients’ area because the funds were raised by volunteers? How about someone coming in voluntarily to reassure nervous patients? Perhaps you’d like a group you could ask for feedback about planned changes to your website. Such actions and activities are typical of Patient Participation Groups (PPGs), which are now common in, among other healthcare settings, GP practices. Indeed, these groups were actively encouraged by NHS England, and, from April 2016 a contractual requirement (of the GP contract). Some practices, encouraged by their CCG, are seeking to establish youth PPGs and child PPGs.
The Health and Social Care Act 2012 requires CCGs and commissioners in NHS England to enable ‘patients and carers to participate in planning, managing and making decisions about their care and treatment, through the services they commission’.
The NHS document Five Year Forward View, makes clear the ‘need to engage with communities and citizens in new ways, involving them directly about the future of health and care services.’ The King’s Fund took up this theme and published recently Patients as partners Building collaborative relationships among professionals, patients, carers and communities (http://www.kingsfund.org.uk/publications) following its launch of a national development programme ‘Leading collaboratively with patients and communities’ in September 2015. This in turn was a follow-on from the King’s Fund exploring the concept of patient leadership – a term taken from the Centre for Patient Leadership (CPL). Founded by David Gilbert and Mark Doughty, the aim of the centre is (according to its website) ‘learning and support to enable patients, service users and carers to become influential leaders and effective agents of change in order to:
- Improve the quality of health services
- Promote health and wellbeing within their communities
- Generate solutions to current health care problems.’
CPL offers The Engagement Cycle, ‘a strategic tool that helps commissioners (of health and social care) to understand who needs to do what, in order to engage patients, communities and the public at each stage of commissioning.’ Aimed at CCGs, the Cycle (see http://engagementcycle.org/engagement-strategy-culture-and-systems/) is nevertheless instructive for healthcare providers suggesting that Engagement strategy, Culture and Systems are two-way processes involving:
- Working with communities to identify needs & aspirations
- Working with the public to plan and transform services
- Working with patients & carers to improve quality & safety
- Working with patients & the public to procure services
- Working with patients & carers to monitor services
The PPG model
Although PPGs are often considered a modern phenomenon, the first ones were established around 1972 by GPs in England and Wales. They were given greater prominence following the NHS England Statement on involving the public in primary care commissioning (September 2015 – Gateway reference 04106) but clearly identified with GP practices. For dental, pharmacy and optometry (eye health) services, this document stated that NHS England organises local professional networks (LPNs) – members of which ‘can include individuals, local patient groups and voluntary sector organisations, service providers, and commissioners’. This suggested membership is at variance with PPGs which are ‘made up of patients from the practice’.
LPNs also cover a larger geographical area (and hence number of dental practices) than do PPGs, which are aligned to just one GP practice. According to the NHS England list of Chairs of Local Professional Networks, there are 25 areas with LPNs, such as North Yorks and Humber, Derbyshire and Nottinghamshire and so on.
In terms of setting up (strictly speaking, encouraging the setting up by patients) a PPG, GP practices have extensive help and advice via the National Association for Patient Participation (N.A.P.P.) – see http://www.napp.org.uk. There are guides for healthy PPGs, best practice for PPGs, virtual PPGs (based on email and social media networks) and resources for PPG members. PPG Awareness Week was 6 to 11 June 2016.
Let’s start by looking at KLOEs. R1 (as you know) states: ‘Are services planned [bold in original] and delivered to meet the needs of people?’ An example of demonstrating this is happening is given as: ‘There is evidence that the provider gathers the views of patients when planning and delivering services.’
W4 is: ‘How are people who use the service, the public and staff engaged and involved?’ One of the examples of evidence of this is: ‘The provider has processes in place to actively seek the views of people who use the service and those close to them, and should be able to provide evidence of how they take these views into account in any related decisions.’
Clearly, dental practices don’t need PPGs to meet these KLOEs because many have passed CQC inspections. So, do PPGs offer other benefits? In addition to the examples I used to begin this article, here are some others of what PPGs have done.
Smile Works, a dental practice with four surgeries in Telford, has an active PPG and was therefore chosen by Shropshire and Staffordshire Area Team as an early adopter site for the primary care (dentistry) testing. The collation and presentation of the findings were carried out by a patient.
The NAPP website gives examples of where PPGs have made a real difference, including: ‘Undertaking monitoring of services through patient polling, and feeding back to the practice’.
In a surgery in Cookham, the PPG discussed the complaints procedure with the aim of ensuring ‘that the processes and outcomes meet the patient needs’. It discovered that one complaint reviewed would not have happened if the patient had known about a particular service.
Phoenix Medical Practice has a virtual PPG because feedback from patients at the time of setting up a PPG was that their time was limited. Nevertheless, the PPG has developed, completed and agreed action plans on numerous surveys, which have helped the practice: ‘gain an understanding of what our patients want from the service we provide’.
I also know of PPGs that include members with professional knowledge they have passed on to team members – recognising the signs of a patient having dementia and communicating with them appropriately, for example.
Although it will take resource and effort initially, an established and effective PPG could prove most useful to your practice. Not only could it support and even raise the finance for in-house initiatives but it could look to the wider public and help you determine which services you should consider offering, how effective (or otherwise!) your marketing is and provide a repository for your patients’ grumbles, observations and positive suggestions.
About the author
Amanda Atkin is a change management consultant, focusing on the healthcare sector in which she has considerable expertise and experience. Amanda's skills range across contractual management, performance management, operational delivery and leadership development to strategic planning as well as governance and regulatory compliance.
e firstname.lastname@example.org www.atkinspire.co.uk