Patients and Information Open House: Report on the

Patient participation in general practice workshop

Tuesday 17 June 2014, Ark Centre, Basingstoke

1. Introduction
The workshop was introduced by Emily Carter, Regional Head of Patient and Public
Voice, and Martin Smethers, Chair of the Fordingbridge Surgery Patient Participation
Group. Information was provided about existing mechanisms to involve patients in
general practice and new NHS England initiatives; such as the introduction of the
Friends and Family Test to general practice from 1 December 2014 and the 2014/14
GP contract with incentives for participation and working in partnership with patient
participation groups. Participants were tasked with discussing what needed to
happen to improve patient participation in general practice.

2. Summary of feedback from workshops discussions
Notes from the workshop discussions are provided in Appendix 1, grouped by
theme. A brief summary of the feedback provided is below:
Patient participation groups (PPG)
Lots of suggestions on what makes a successful PPG from experience of
people in the room for example constructive working relationships with the
GP practice and having a clear purpose
Importance of links between PPGs and Clinical Commissioning Groups
(CCGs) and local Healthwatch organisations
Ideas for what would help PPGs prosper:
o Sharing of best practice
o Networks of PPGs, potentially linked to CCGs
o Clarity on the role of PPGs from NHS England
o Role for Care Quality Commission (CQC) inspections to promote
importance of PPGs and patient involvement

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Changes to participation element of GP contract
Concern that as an optional part of the contract and with less money per
registered patient attached compared to previous years that GP practices will
not choose to participate
Suggestions made that in future years this be part of the core contract and not
an optional part, or that money per patient be removed if not complied with as
opposed to given if complied with.
Many people not aware that this change has happened
Friends and Family Test (FFT)
Very low awareness that this is coming to general practice
Benefits of introduction of FFT recognised by participants, providing:
o a consistent approach to administering and analysing the survey is
taken allowing comparisons to be made with other local practices
o response rates are sufficiently high enough and provide a
representative sample of the practice population
o balance of positive and negative feedback is reviewed and acted upon
Suggestions of other ways for patients and the public to engage in general practice
Need to involve children and young people go to youth clubs; using social
media (such as twitter and facebook);
Outreach into community speak with people who dont take part in existing
activities e.g. often ethnic minority communities; young people
Discussion of barriers to people getting involved

3. Actions in response
The feedback received was really helpful and this is how the NHS England South
team will be responding:
a. Communications with PPGs, GP practice managers, CCG lay members, CCG
patient engagement leads and local Healthwatch organisations on resources
available to support PPG development. This includes: National Association of
Patient Participation framework for healthy PPGs.
b. Communications with PPGs, GP practice managers, CCG lay members and
CCG patient engagement leads on changes to GP contract element on
patient participation and promoting the outcomes of the pilot in Swindon
testing out ways of working between PPG and GP practices to review patient
feedback
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c. Learning session(s) for PPG members and GP practices on ways of working
together to review patient feedback delivered before the end of February
2015
d. Support available to practices on how to implement the Friends and Family
Test in general practice accessed via the NHS England Area Teams
e. Communications to CCG patient engagement leads and practice managers
with national guidance on friends and family test implementation and
suggestion for practices to work collectively across a geography to provide
consistency
f. Sharing feedback and suggestions received with national leads on areas
covered in discussions, specifically:
NAPP for suggestions on best practice for PPGs to be included in
framework mentioned above
Care Quality Commission regarding promoting PPGs and patient
engagement as part of GP inspections
NHS England national teams feedback on friends and family test and GP
contract


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Appendix 1: Notes from workshop discussions
Patient participation groups
Suggestions for successful PPGs.
GPs to join in PPGs and to value the role of the group
Needs constitution
Funding needs to be identified
Healthwatch to be linked to PPGs
Clear route for resolving issues and ownership of actions
Clarity on purpose and what can be achieved
Need to see progression from issues raised
PPGs need to be independent of practice co-operative and not
confrontational
Sustain interest must feel worthwhile
Ownership with deliverables
PPGs need to have independence from practice providing constructive
criticism and ideas and work collaboratively with the practice
People need to see benefits
Feedback needs to be acted upon otherwise public lose confidence in PPGs
PPGs to be set up as newly established need to be independently minded.
Need a marriage co-operation work together include a strong
chairman
Ensure minutes of meetings are taken
Make PPGs democratic and representative PM only one with authority to
appoint members
PPG meetings are not for complaints
PPG to have an annual meeting
PPGs can help Healthwatch and support those functions
What support would be useful for PPGs?
To see examples that they can drive positive change
Link with Healthwatch and CCG corporate processes (engagement,
educative) but capacity is an issue
Sharing best practice (calls on busy peoples time)
o Awards of some sort?
o Continuous improvement
Good PPGs could share best practice
Need someone i.e. CCGs to pick up issues \ actions \ outcomes and then
share these more broadly
Umbrella meeting monthly of PPGs; getting patients interested and involved.
Good links with Healthwatch
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Aims in terms of deliverables by NHS England, CCG, GPs, PPG
Need national independent anonymous surgery PPGs. Obtain proper
statistics from significant surgeries with a good representative sample.
A national Association of PPGs could co-ordinate.
Development of forums to ensure better link-up between PPGs and also with
Healthwatch
PPGs joining together for area forum with CCG involvement
How to recruit new members
If several PPGs in the same town, have combined meetings
Primary care hubs
Ideas for promoting PPGs with GP practices
Now that CQC inspecting GPs, could enquire why particular GP Practices do
not have PPGs. GPs need to meet certain standards
Find out how many practices are having problems setting up a PPG
See PPGs as an ally, not a threat
PPGs should be an ally rather than a threat
Has to be business value/opportunity cost rather than ad hoc
Suggestions for PPGs to communicate with wider community.
PPG information could be included with the patient prescriptions
Fetes, meetings, PPGs need a budget
Local websites, town Facebook, email. Prefer to face-to-face
PPG could have a separate website independent of the GP practice but linked
PPG patient group surveys 6 month of replies could be provided on a website
to include CCG notices and surgery replies. Patients could put up a question for
answer
Changes to participation element of GP contract:
Until it is mandated it is not going to happen and will not be meaningful
This is being seen as a tick box exercise for many practices. However, there
is real potential for this to be carried out meaningfully
Could be that money taken away if not carried out, rather than give money if
they do?
PPGs needed to be organised such that issues could be discussed and
actions taken to resolve so that there are positive outcomes
Could enhanced service specification become part of the core contract?
Patient feedback indicate 2 very different results from survey by GP practice
and survey from local residents also independent of GP practice
Issues duplicated between PPG and GP practice which needs to be resolved
Patient survey and PPG; issues responded to ie matters of privacy. Evidence
based.
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Ensure patient views are heard and responded to
Friends and Family Test
Raising awareness
This is mandated how is it advertised?
Need for communication to community to practice and to PPG
Health workers unaware of friends and family questionnaire
Patients may not bother if they think the survey is for a foregone conclusion
Consistent approach
What outcomes are we expecting?
Needs to be consistent with independence in how it is administered and
analysed
Needs a uniform approach across CCGs to get involved with your practice
on how it is administered and analysed
Comparisons could be made reference against, compare and contract
against other GP practices
Positive feedback as well as negative
Transparency or feedback. Maybe tablets .. forms that can privately give
feedback; collated and made public
There may be a much lower response and therefore not representative.
Sharing the results..
Friends and Family needs to be reported back independently
Patients dont want to complain, or be negative in the surgery, so who will
view/receive the FFT Test outcomes? Will it be available at local PPG level?
Should FFT Test / PPG feedback and action plan be publicised and audited?
Will it influence patient opinion?
We need to give good/positive feedback to GPs so that there is balance
patients receive feedback / follow up to know complaints are acted upon and
making improvements.
Other ways to engage in general practice
Social events to bring in patients
Meetings could be carried out in a neutral place library.
It was queried whether PPGs were the only method? Could NAPP (National
Association for Patient Participation) carry out health education sessions
patient to patient level?
Concept is of good citizen involvement in the NHS
Healthwatch right to enter and view. A communication tool.
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Need to connect with youth potentially to go to youth clubs etc and work
with them to discuss issues via social media. Also visit groups of older people
GP practices open up via Facebook and twitter for young to comment, older
people could use feedback forms
Those running groups can get feedback from their members. Patient
representatives can get informed feedback from those people who may not
want to be on the PPG e.g. young people. Young people may use twitter and
other social media
People do not want to work with intermediaries they want to speak directly
and hear what is going to happen as a result need transparency. Example
of www.evolve.com
NHS England questionnaire for whole country from a non-biased opinion
Accessibility needs to be considered
Important to better target hard to reach groups, which includes non-UK
citizens and young people, to get their views
Multiple ways of communicating
Elderly social exclusion social media
Need a timescale for response to comments for example 7 days.
Engage with Healthwatch and local CCGs to put pressure on surgeries
Get the Practice Manager to give a talk to a group of patients How can I be
a better patient positive feedback rather than negative
What is the national and regional role?
Working as partners working together
Patients understanding context of surgery as well as GPs understanding
perspective of patients.
Perceived barriers to participation in general practice:
Patients worry about giving personal time
Patients worry about being struck off if complaints made one person
advised having experience of this
Some PPGs viewed as small hand-picked group by invitation only from the
GP
GPs may not have time to carry out analysis of information provided from their
patients
PPG members usually older say over 60 so not fully representative of the
practice
Apathy - people think they will not be listened to; dont know what is going on;
dont know where to go
Difficult to get patients to engage with PPG
Some GPs dont encourage patient engagement and dont have a PPG
Less than 50% feedback is not a true picture