How GP practices engage and involve local communities in primary care is incredibly important, both in terms of reducing health inequalities and hearing and acting on feedback.
One of the principles of the NHS Constitution for England states that "The patient will be at the heart of everything the NHS does". This means involving and consulting patients, their families and carers on all decisions about their care and treatment. The service should also actively encourage feedback from the public, patients and staff to improve its services. Providers should support individuals to share decision making, and promote and manage their own health where appropriate. NHS services must reflect, and should be coordinated around and tailored to the needs and preferences of patients, their families and their carers.
This means patients should be seen as people with skills, ideas and knowledge that could benefit the whole patient population.
Patient engagement and patient involvement
A research paper from the King's Fund on quality of patient engagement and involvement in primary care defines these terms:
Patient engagement: how patients are engaged in primary care consultations regarding their health, care and treatment.
Patient involvement: how patients (both as individuals and groups) are involved in the design, planning and delivery of primary care services at the GP practice or health centre level.
Patient engagement
The role of the patient is no longer as a passive recipient of care. GP practices are expected to engage patients in their own health, care and treatment. Guidance by NHS England about involving people in their own health and care explains how this is a legal duty, so people experience better quality care and improved health and wellbeing, as well as enabling the system to make more efficient use of financial resources.
Engaging patients in their own care can involve a variety of flexible approaches. For example, bringing people together in group consultations for support with long-term conditions, which can help them to manage their own health by sharing their experiences and learning, or using ‘patients by experience’ groups. NHS England has published information on group consultations.
Patient involvement
The National Health Service (Personal Medical Services Agreements) Regulations 2015 state that providers must establish and maintain a group to obtain the views of patients about the services they deliver and enable them to obtain feedback.
The regulations refer to this as a patient participation group (PPG). In practice, this does not need to be a formal PPG with specific named members, a chair and a secretary that records minutes of meetings. It can also be a ‘group’ made up of the full patient list. Practices can gather feedback in any way they feel is right for their patient population. They may find they can have more effective conversations through engaging with different community groups at different times and in different places. Practices may also choose to use digital technologies to engage with patients to reach more people, such as SMS messaging, social media and other online methods.
Using a more innovative and flexible approach may encourage certain patient groups to participate or access care, and takes into account any cultural, socioeconomic and ethnic backgrounds. It can enable a practice to ensure that the membership of its PPG is representative of the registered patient population, and that feedback about the service is meaningful and reflects all patients - not just a specific age group. This is because younger people, those of a working age or those with young families may not have the time to attend a meeting in person, or may not want to join a group.
NHS England encourages practices to take a flexible approach to ensure they hear and act on the voices of people and have effective conversations with different community groups. NHS England has published guidance on effectively working with people and communities.
It has also published information for patients on how to give feedback.
Integrated care systems
Following the new Health and Care Act 2022, GP practices will become part of integrated care systems (ICSs). NHS England has set out a plan for how ICSs can work with people and communities. This will enable them to have:
- a stronger voice
- more information and control over their health
- more choice
- help to design services.
Guidance on developing partnerships with people and communities provides 10 principles for working with people and communities that can also be used in general practice. The principles encourage people to have an active role in decision making, evaluation, governance processes and access to clear and accessible information.
When we inspect
Regulation 17 (Good Governance) includes the assessment, monitoring and improvement of services and seeking and acting on feedback.
We look at how GP practices encourage creative ways of delivering equality of experience, outcome and quality of life for people. We assess how providers identify and embed good practice and how easily people can share feedback and ideas or raise complaints about their care, treatment and how the service is delivered. We assess how people can get clear and accessible information about what has changed as a result of their involvement and engagement.
When we assess GP practices, we also review GP patient survey data to establish variation with local and national averages and look for the actions that practices have taken in response. This helps us to plan the focus of an inspection.
We may also ask for evidence to show how the service engages with and involves people, and how it meets the needs of the practice population. Evidence is not limited to minutes of meetings and can include photographs, social media coverage and other creative media sources.
Other information:
https://www.kingsfund.org.uk/projects/gp-inquiry/patient-engagement-involvement (The King's Fund)
https://evidence.nihr.ac.uk/themedreview/improving-care-by-using-patient-feedback/ (National Institute for Health and Care Research)
Resources for more on population health management (NHS England)
Next steps for integrating primary care: Fuller Stocktake report, NHS England, May 2022 (NHS England)
GP mythbusters
SNIPPET GP mythbusters RH
Clearing up some common myths about our inspections of GP and out-of-hours services and sharing agreed guidance to best practice.