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Terms of engagement

Terms of engagement

Insight: patient engagement
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Dr Mike Warburton
Director, Capita

 

A broad range of national bodies, such as the British Medical Association, the Royal College of GPs and patient groups, have long endorsed the principle of engaging patients in the NHS, and this principle is underpinned in legislation. In the process for clinical commissioning group (CCG) authorisation and Care Quality Commission (CQC) registration, there is even a financial incentive for practices that take part in the Patient Participation directed enhanced service (DES).

Dr Mike Warburton
Director, Capita

 

A broad range of national bodies, such as the British Medical Association, the Royal College of GPs and patient groups, have long endorsed the principle of engaging patients in the NHS, and this principle is underpinned in legislation. In the process for clinical commissioning group (CCG) authorisation and Care Quality Commission (CQC) registration, there is even a financial incentive for practices that take part in the Patient Participation directed enhanced service (DES).

However, when so many people are telling you why you must do something, it is easy to overlook why you might want to undertake public and patient engagement (PPE).

In every CCG, the joint strategic needs assessment will inform practices and CCGs of the specific health needs of the population down to ward level and below. But how can PPE help you achieve one of the core aims of general practice and CCGs  – to meet the health needs of your community?

PPE can help meet those needs in three key ways:

  • By gaining a better understanding of how the community would like those health needs met. For example, what type of services? Located where? Open when? And what has been the experience of the current service?
  • By developing systems and processes for informing patients how services have changed, and how to use services most effectively. For example, GP services, A&E
  • or pharmacies.
  • By supporting and enabling individuals and communities to maintain and improve their own health.

Practical solutions
A PPE truism is that there is not just one way to approach achieving these aims.

Communities can vary hugely across the country, counties and even across boroughs. So when choosing a technique or an approach it is essential this fits with your community.

It is also wise not to start from scratch, as you will almost certainly have some PPE infrastructure within your PCT, local authority and/or within voluntary organisations. If it is effective then consider building on it. If, in this climate, it is ineffective or too costly you may need to look elsewhere.

In 2010 the Department of Health helped around 25 CCGs look at different ways of supporting the implementation of their goals (see Resource).

For the GP who is approaching this for the first time, the variety of approaches can be potentially confusing and may slow a CCG's progress. As patient and public engagement is such a fundamental first step in the life of a CCG, this potential delay is exactly what needs to be avoided. The following describes a simple way of meeting some of the needs of a PPE framework and covers the three goals set out above.

How to…
The DES provides some financial incentive (£1.10 per patient) to set up a patient group, ask them their priorities, and survey those patients on those stated priorities. This can be done via an existing Patient Participation Group (PPG) or a virtual group (vPPG). Traditional PPGs can provide fantastic support and resources to help practices but unfortunately they are often not truly representative of their community and, therefore, do not help the practice comply with the DES requirements.

Virtual groups can be nothing more complex than an email list of patients who have given permission to be contacted by the practice and, as such, are relatively easy to establish, easy to get to be representative and easy to maintain and grow.

To achieve the three aims, some key practical tips are:

  • At the outset ask the patient's permission. For example, say that you would like to be able to ask them about your services, advise them about using the service effectively and help them manage their own health. Include that you will only contact them a maximum of six to eight times a year by email.
  • Recruitment is best with a printed form that captures your aims and collects their email address and demographics. Example forms can be found at the NHS Networks website (see Resource).
  • Ask all doctors and nurses to hand a form to every patient they see and ask them personally to join the group. Also make the forms available in the waiting room and on the reception counter. Ask all new patients to join and routinely collect email addresses.
  • Once you have a long list of email addresses it is worth coding these patients and keeping the details within your clinical system so you can ensure it remains up-to-date and that you don't send emails to people who have left or died!
  • If you have asked the patient whether they would be interested in a particular area of service – eg, do they have a long-term condition, or are they a carer? This will allow you to target communications in the future and to ask specific groups questions relating to a particular service.
  • To ask questions or survey your patient email list it is worth getting comfortable with an online tool. These collate responses and simply send you back the results. Of the range of online tools, www.surveymonkey.com is probably the best known. Primary Care Commissioning provide a support service that includes an online survey, results and a bank of questions to pick from (enquiries@pcc-cic.org.uk).

However, as well as asking questions (eg, to fulfil the DES), having developed the infrastructure of an email community now allows you to share practice information, help patients make the best use of local services, such as A&E, or help them to maintain their optimum health (whether that be a long-term condition or, more generally, regarding flu jabs or smoking cessation services, etc). For this reason, recruiting as many people as possible to your group becomes really important and it is as easy to ask 1,000 as it is 100 using an online survey.
Helping patients improve their own health and helping them access the correct service at the right time will remain a crucial part of the practice's responsibility.

As all practices will have to play a part in their CCG, being able to know what your community thinks about a key issue will be invaluable. A virtual community has the potential to help your CCG understand what every part of the locality or CCG thinks on a particular issue, what its specific needs and wants are around the service that you provide or that the CCG commissions. 

If you and many other practices have asked patients whether they would be interested in any particular service area (eg, a long-term condition) it allows you to develop care-specific patient groups across a locality or CCG – these can be invaluable for targeting advice to keep people healthy and improve management of long-term conditions. If this builds on existing local voluntary groups (for example, your local Diabetes UK group) or a whole variety of other voluntary groups that represent particular sections of the community, you can start to build into a truly powerful virtual voice for patients and a really important tool for health professionals and managers to communicate effectively with patients.

Virtual patient or customer groups are not new. If you are a home internet user, just think how many emails you get from companies you have bought something from in the past and who keep your details to let you know of new, exclusive deals. You are part of their virtual customer group. However, we also know how annoying unsolicited email can be and so telling patients that you will only contact them, for example, six to eight times a year could be important.

Nevertheless, if you consider how, for instance, a retail company engages its customers' attention, it is usually more than just an email. It will be a whole host of other activities that might include advertising, focus groups, complaints and feedback. Virtual patient groups are the same. Patient engagement isn't about one simple email; it is about a whole range of communication techniques that help a two-way dialogue. This dialogue helps us understand patients' views and allows us to communicate with them more effectively.

Primary care is in a uniquely powerful position of being in constant contact with patients and holding a respected and trusted position in society. Building on that foundation and using some simple technological methods of engagement, general practice has the potential to revolutionise the interaction of patients and professionals, and give patients and communities their true voice.

Resource
NHS Networks

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