This site is intended for health professionals only


Engaging with hard-to-reach groups



Commissioning consultant Scott McKenzie gives an overview of how GP commissioning is set to enhance engagement with hard-to-reach groups

Hard-to-reach patients are often not in contact with any services, as they are either unaware of them or do not wish to access them. Services often struggle to identify and make contact with such individuals. However, GP commissioning should find new ways to tackle the problem.

The public health budget has been ring-fenced and a new public health service will be created to integrate existing health improvement bodies. And with PCT responsibilities for public health set to transfer to local authorities, the latter will become an important partner for commissioners to work with. The new NHS Commissioning Board will hold commissioners accountable for outcomes in healthcare services, meaning GP commissioners will have to tackle this thorny issue. At the same time the reform of adult social care can only help the process.

The key, of course, will be leadership of the process. This will require someone at a national and local level, who is known for, and can deliver, extraordinary performance, with the goal of achieving outstanding results. The results will then serve as an inspiration to others to perform at an exceptional level. Transformational change is what is now required, not more of the same transactional approach.

Part of that transformational approach should be driven by health needs profiling, mapping of available resources and shaping services to address priorities and deficits. It will also need to include seamless pathways of care, rather than everyone working in silos as we currently do, with little contact between the constituent parts. Vitally, it will now need to include input from patients, who will have easy access to the information they need about the best GPs and hospitals.

It could even be that we adopt a completely different approach, for example using mobile health clinics, satellite clinics, home visits and drop-in centres to make services more accessible, possibly through commissioning new GP and community-based services. The texting for sexual health service featured on page 26 is a good example of how innovatively GPs can commission when they are given the opportunity. And the gynaecology service on page 29 shows how primary care is more than up to the challenge of creating user-friendly services in a general practice setting.

Partnership working between organisations is key. Also key is a willingness to gather patient or public views, analyse the feedback, turn it into action points, which will be reflected in changes to service delivery while also providing people with feedback on what has happened as a result of their input. The new single contractual and funding model for GPs, which is likely to include an adjustment for quality, and incentives for improving access to primary care services, will help. If the new contract retains some of the best elements of the existing PMS contract model, it would allow for flexibility to tackle local needs, such as the hard-to-reach patients.

Into this we should be able to attract the voluntary sector. Often they have much better access to the hard-to-reach groups and are better able to market to them.

Scott McKenzie is an independent commissioning consultant

Engaging with hard-to-reach groups presents a real challenge for GP commissioners Engaging with hard-to-reach groups presents a real challenge for GP commissioners