Commissioning: GP-led NHS - Boosting patient involvement

The importance of good communication with patients and public cannot be overstated.

The government’s ‘big society’ health programme is aimed at giving greater power to communities (Photograph: Istock)
The government’s ‘big society’ health programme is aimed at giving greater power to communities (Photograph: Istock)

It is clear that GPs really will be in the driving seat when it comes to commissioning services for their local populations. However, with this power comes responsibility and it is not just fiscal.

GPs will be directly accountable to the people who use the services they commission for the first time since the creation of the NHS.

When announcing his proposed reforms, health secretary Andrew Lansley said: 'With this White Paper we are shifting power decisively towards patients and clinicians.' The intention is therefore not only to give clinicians greater control but for patients to have more choice and control, helped by easy access to the information they need about the best GPs and hospitals.

It is also worth noting that the government's 'big society' programme is also aimed at giving greater power to communities and individuals.

As far as individual practices are concerned, more information about performance will be in the hands of patients and the public and as for GP consortia, they will have to get used to the idea that they are patient-facing organisations.

The importance of good communications cannot be overestimated and it goes two ways.

First is communication from the users of services to the consortia. Consortia must be able to engage patients and the public to make sure they are delivering the services that are needed.

PCTs currently have this responsibility and it is fair to say, that for many, it is little more than a tick box exercise. All too often patient and public involvement (PPI) has amounted to little more than a couple of focus groups attended by the predictable few.

Good patient and public involvement
  • Knowledge - Provide relevant and up-to-date information about your consultation in a variety of formats in plain English (and ethnic minority languages).
  • Ability - Ensure that all sections of the population are able to participate. Provide support to enable this where necessary.
  • Internal communications - Ensure staff are aware of the consultation, what its aims are and how to signpost the various ways to participate.
  • Openness - Always be as open as possible when dealing with patients and the public.
  • Responsibility - Greater patient and public involvement should be designed to encourage the local community to take responsibility.

Local health services
Some GPs may think they already know what their patients want. After all, they listen to them in the consulting room. However, this is not the place to find out what the community thinks about local health services.

More importantly, there are some patients who rarely attend, so you are missing an important constituency by relying on the people that turn up at the practice door.

There are some basic considerations for good PPI. Ensuring people know that your consortium wants its population's views is the first step. You should use plain English and jargon-free language. Be prepared to translate into different languages and consider different ways of reaching your audience.

Leaflets are often seen as the best way to communicate but they will not reach all sections of the community. Some people need help to contribute to PPI because of physical or intellectual considerations. You may have to provide support to make sure they can play their part.

You should also make sure that everyone involved in your organisation understands what you want to achieve through a local consultation exercise.

This means your message should be consistent. The people working for your consortium and at member practices will be your best ambassadors. Away from work many will have friends or relatives in the local community.

Effective communication
The second part of your engagement effort is effective communication back to patients and the public. You must be able to explain any changes to services in a clear and consistent way.


Mr Girach: 'If patients and public have been involved in the discussion they should be able to understand how changes you are making reflect their views.'

Clear communication is vital to help patients to understand how they are supposed to navigate their way between health providers. If there are changes to services, good signposting will help patients make choices that are best for them and ultimately improve outcomes.

Communication to patients and the public also involves handling the local media which is often hostile to any service changes and tends to stand up for the traditional view that the performance of local health services is linked to the number of hospital beds. Good media handling skills are a must for any GP consortia engaged in commissioning services for the local population.

There are organisations such as National Voices (www.nationalvoices.org) that can provide support and guidance on effective PPI. There are also communications and public relations experts if you need extra support.

Benefits of effective PPI
  • Better quality and more responsive services.
  • Better outcomes of care.
  • Reduction in health inequalities.
  • Local ownership of local services.
  • Greater understanding of patients' needs and why and how local services need to change and develop.
  • Supporting people to look after themselves and make the best use of services.
  • Improved relationships between patients and healthcare providers based on trust and mutual respect.
  • Increased confidence that services will be delivered in a way that the patient prefers.
  • Mr Girach is special adviser on social enterprise and co-operatives to the NHS Alliance
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