This site is intended for health professionals only

At the heart of general practice since 1960

The patient pioneer helping lead commissioning

Patient and public involvement must be at the core of your organisation, according to a large Leeds PBC consortium with a lay executive board member.

Patient and public involvement must be at the core of your organisation, according to a large Leeds PBC consortium with a lay executive board member.

Leodis Healthcare is a PBC consortium of 30 practices covering 210,000 patients in east and south Leeds, which manages a £90m budget. It has embraced patient and public involvement to an extent not commonly seen to date among other PBC consortiums by appointing a lay executive board member.

41203071That postholder, Gordon Tollefson, Leodis' GP chair Dr Andy Harris and chief executive Chris Reid explain how their model works.

Why did Leodis decide to create the role of lay board member?

Dr Andy Harris (AH): We realised that patient and public engagement (PPE) was becoming more and more central in any service development.

It's fairly central to Healthcare Commission standards for better health, and we were also informed by meetings we attended when developing our thinking on PBC, run by the Improvement Foundation, and also conferences run by the National Association of Primary Care.

It became clear we needed more than just a patient representative; we wanted to avoid tokenism and needed to appoint somebody who would have a strategic and proactive approach to patient involvement. We put out an advert, interviewed five people and selected a high-quality candidate in Gordon.

Gordon Tollefson (GT): I think it's quite significant they decided to reserve one of their 10 executive board positions for an appointed person from the community.

They also have six GPs, two practice managers and a chief executive and when they voted for GP and practice manager members, there was a disappointed applicant in each case.

If they wanted, they could have said, let's scrap that patient and public involvement position and put one of them on instead. But they continued with the principle of wanting to put patients at the heart of Leodis, which is tremendous.

What is the scope of the role?

GT: When I came to interview, they confirmed I would be a full board member with full rights to speak on anything – it wouldn't just be a case of speak when you're spoken to.

For over 20 years I was chief officer of a community health council and also involved in voluntary organisations like St John's ambulance and a hospice.

In my latter years before I took early retirement at 59 (he is now 61), I worked as a senior manager in the ambulance service, where I also picked up the mantle of PPE.

CHCs used to have an observer position at the health authority, but there's a vast difference between that and the real and credible position of being a full board member.

Originally I started at Leodis on one session a week, and that has increased to two. We also have the support of the PCT with a secondee who does a lot of grassroots community networking.

Chris Reid (CR): I've worked as a chief executive of a PCT and other senior positions in the health service and I don't think Gordon's role is very common among PBC groups.

Instead of asking a patient representative to just turn up to a monthly board meeting, his one day a week gives him the scope and time to really get into the guts of the agenda. He's not just a token representative, he's someone on the top table who feeds into the strategic thinking and leadership of the organisation.

How is the role funded?

CR: The member practices are financially supporting his role. Half of the £1.90 management allowance given to practices by the PCT is pooled to provide the working capital of the organisation. We modelled his payment on that of a non-executive director on a small PCT.

How has the role changed the way the consortium operates?

GT: One of the top achievements has been the development of a transport policy covering access to proposed community clinics offering outpatient-type services.

All the doctors on the board have individual responsibilities for delivering the PBC agenda and they now each attend and present business cases to the patient advisory group (PAG) I've set up.

The group meets monthly and is currently made up of eight people who had previous PPE experience on the five PCTs that preceded Leeds' current single PCT.

The group will challenge doctors over any issues they have and then decide afterwards whether they're happy or not to support business cases. The PAG members are not reimbursed for their time, but they are for their expenses.

At one of the meetings, PAG members pointed out that in this city, all the ideal public transport links and corridors flow into the city, but we don't have those same links across the city, so they asked whether this would cause patients more problems in getting to the new services.

I took those concerns to the board and within a month, a transport policy was drawn up and put to the PAG. That policy describes a discrete transport provision whereby, if there's a need, a local taxi firm will collect a patient from home, bring them to the clinic and then straight back home afterwards.

Obviously if someone's got three cars in their driveway, transport won't be provided, we've got to be realistic, but one of the qualifying criteria would be that a patient has to use more than one bus to get to the clinic – such as catching a bus into the city and then back out again.

We also want commissioning plans that ensure appointment times suit the patient – such as in the evenings.

The PAG has assessed about eight business cases so far and other themes, aside from access, that have emerged are whether care provided in a community setting is the best care that can possibly be provided if they have a complex problem.

GPs were able to reassure them that patient choice is a key feature. If patients prefer to be referred directly to hospital, they will be.

Another issue raised by the PAG was cradle-to-grave care, about a new local enhanced service the consortium is planning. We're offering care home patients the opportunity to reregister with one of six practices in Leodis, which will be visiting the home on a regular basis and giving telephone advice to staff about patients who seem to be deteriorating.

This should stop patients being shipped off to hospital and disrupting their routines unnecessarily, when they actually just need a doctor's assessment. If one of the nursing home patients who's been registered with a GP they've known all their life says no to reregistering, the PAG was told there will be no pressure to move them.

However, we will be telling patients and relatives about the advantages of the enhanced service – the six practices involved will be able to offer preventive care and the services of the extended primary care team, for things such as flu injections done at the nursing home.

I've also talked to the doctor leading diabetes service redesign about whether one patient representative was enough, especially if they only understood about type 2 diabetes and not type 1. He accepted that and now has two patient representatives involved.

The board has also endorsed a strategy for carers, covering six key areas such as practices being flexible and taking account of the needs of carers when making appointments.

We're also looking at harnessing the Expert Patients Programme for long-term care. It's not just about ‘power to the patients', it's the fact that informed patients will actually bother GPs much less.

If the group really disagreed with a business case, my approach would be to talk to the lead doctor involved and work out a compromise, and by the time it reached a board meeting, it would be up to the doctor to describe what had been altered and for the chair to check I was happy with it.

AH: The concerns the PAG has raised, about moving low-complexity work out into the community, mirrored most of the GPs' concerns as well – over quality of services, access to services and fragmentation of services.

The transport policy was certainly drawn up in response to issues of access and costs for this will be built into business plans. We will try to take on as much as we practically can from the PAG.

The other thing Gordon has done, which has been very impressive, is made PPE a standard agenda item at the regular practice managers' meetings and that's led to patient groups being established within Leodis practices.

Any employees of Leodis also have PPE incorporated into their job description.

Were GPs initially sceptical about PPE and has this changed?

AH: From my point of view, and I suspect a lot of the members', there was quite a lot of ignorance of PPE and the breadth of what it involves.

To some extent we saw it as something we needed to do, rather than something that was going to produce a great deal of benefit. As Gordon's work has developed, that view has completely changed around.

CR: I think it was a bit of an act of faith initially. Gordon's skills have changed people's minds from thinking ‘it's a good thing to have', to really recognising the true value of having someone who can help us work through the issues.

In many ways, the best defence for any organisation is that the patients are being played into the thinking, the planning and eventually the evaluation of services.

GT: I would say half of the GPs have had to change their mindset completely. I was told one was totally opposed to patient focus groups and would never have one in their practice, and has now turned around completely.

It's down to showing there's no threat and doctors feeling comfortable in interactions with patients. Some of the credit has to go to PAG members who have demonstrated respect – they haven't launched Exocet missiles at the GPs!

AH: Constructive discussions take place at board level – there are no overt disagreements or antagonism. We mutually take on board other people's views and there's probably more disagreement among the GPs about things than between Gordon and the GPs. It's not about somebody banging on the table – it's a two-way discussion.

Would you recommend your way of working to other consortiums?

AH: Yes. I think you need to appoint somebody of sufficient experience and calibre to be able to take on that strategic and proactive role.

Also, it won't work in isolation – you can't just appoint somebody to do one or two sessions a week unless you can tap into further support from the PCT's PPE department. We've had support from them with someone seconded to help us develop the PPE agenda.

GT: I walked into the board only knowing one of the GPs. What certainly helped were the board development sessions that were facilitated for us – time out to work together.

The company that did it held it over four half-days and it included individual one-to-ones with board members, where you could speak on a confidential basis. It meant I could say whether I thought someone seemed negative towards PPE, to allow the subject to be brought up with that person.

My objective is to improve quality and outcomes on patient care and what I'm preaching is that PPE needs to be routine and systematic. What I don't want to see is PPE pulled out of a drawer, ticked off the list and then people saying ‘that's out of the way for the next 11-and-a-half months'.

It's really good the way people have responded. PBC is a new and exciting development and it's been really exciting to step back into a role I'd enjoyed for a lot of years previously.

Interviews by Rebecca Norris, associate editor of Practical Commissioning

60 second summary Chris Read on Gordon Tollefson Chris Read on Gordon Tollefson

He's not a token representative. He's someone on the top table who feeds into the strategic thinking.

Gordon Tollefson Gordon Tollefson

What we don't want is PPE to be pulled out of a drawer, ticked off then left for another 11-and-a-half months.

Dr Andy Harris (left) and lay executive board member Gordon Tollefson

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say