Public involvement - Consortia boards and lay members

Dr Shane Gordon and Douglas Smallwood say there are compelling reasons to foster lay representation.

Involving the public on GP consortia boards makes business sense (Photograph: Istock)
Involving the public on GP consortia boards makes business sense (Photograph: Istock)

There is a strong business case for GP consortia welcoming patients onto their boards and decision-making forums.

Consortia will of course be accountable to the NHS Commissioning Board, but it is also morally right that there is some accountability to local people for spending around £80 billion of public money in the provision of services to the community. There are also significant advantages for GP consortia in ensuring public involvement is done well.

The challenge of engaging the public is substantial. A recent King's Fund report on the quality of patient engagement and involvement in primary care concluded that local involvement networks are in the main struggling to have any impact on patient involvement in general practice.

Under-resourced work
It states that most patient participation groups at GP practices seem to be about providing feedback rather than influential involvement - and that often the work is under-resourced.

This conclusion is consistent with many attempts by different types of organisations to involve customers or service users in the decision-making process about the service provided. It is just as true, for example, in many large voluntary organisations.

This challenge can be met, but it requires those responsible for the business to be motivated to convert consumer feedback to involvement in decision making.

There are substantial benefits for commissioners from embracing the involvement of the public in this way. First, GP commissioning presents an opportunity to create a more effective and efficient service by involving patients in service design in a way that cannot be achieved easily by PCT commissioners.

GPs are trusted, are respected and constantly accessed by the public. Bringing the consumer's experience of service quality, duplication and gaps to the decision-making forums of consortia can help ensure that resources are applied most effectively.

Second, it will help address the current public concern that is clearly evident about the whole proposition of GP commissioning. Provided it is done well, patients having a seat at the table will demonstrate openness and responsiveness.

Third, patients can be strong advocates for the service. We are all aware that the voice of the patient can be powerful when lobbying their PCT. That power can also support GP commissioning clusters in making difficult decisions about changes to services.

Fourth, inevitably people who use a service are the source of invaluable information that is not immediately apparent to those who fund or provide the service. Having this voice at the decision-making table means richer feedback with earlier identification of problems and opportunities for improvements to services.

Customer feedback
Public representatives on GP cluster boards may also contribute to, and even lead, a rich programme of communication with their population. This might include ensuring that systematic customer feedback is gathered from all services to assure the patient experience aspect of quality (alongside safety and clinical outcomes).

Representatives may also help to lead public engagement events and to recruit appropriate lay people into service redesign workstreams.

More sophisticated methods of gauging public opinion about health services may also be employed including formal surveys. New media inputs, such as Facebook or Twitter, might also be developed.

None of the above will succeed unless the leaders of GP consortia invest in public involvement in terms of time and money. Overcoming the problem of the 'usual suspects' (the handful of local people willing to play a role) needs a thorough and open recruitment and selection process.


Douglas Smallwood: Public representatives on GP cluster boards may also contribute
to, and even lead, a rich programme of communication with their population

Patients invariably require training and support to help them make the most effective contribution. There are many patient-based charities that do all this successfully so it should prove possible for GP leaders.

It would be inconsistent to embrace public involvement as described above and not look simultaneously to improve individual patient engagement in their own health, care and treatment.

Here the commissioner has a crucial role to play. We have the chance to make sure the services available are the same as those the individual healthcare professional and patient want to access. Having the voice of the patient at the table will help to develop consistency between what is commissioned and what is wanted.

The political drive for 'no decisions about me without me' resonates with some but not all. Irrespective of philosophy, GP commissioning consortia will be more successful if they embrace both public involvement and patient engagement.

Why involve patients on boards?
  • There is a moral and practical case for the involvement of the public on GP consortia boards.
  • Public and patient contribution must move beyond consumer feedback into active involvement in decision making.
  • There are substantial benefits to embracing this approach, including better insight into the efficiency and effectiveness of services, strengthening the legitimacy of GPs as local commissioners, advocacy to support difficult service changes and vital 'soft' intelligence.
  • Successful public involvement will require investment of time and money. Open and thorough recruitment of patient representatives will be crucial.
  • Public representatives on GP consortia boards will have a role to develop and champion richer public involvement in commissioning.
  • Patients' engagement in their own health and care complements this approach.

 Visit our GP Commissioning resource centre

  • Dr Gordon is co-lead of the NHS Alliance's GP Commissioning Federation and Douglas Smallwood is chief executive officer of charity Diabetes UK

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