GP commissioning consortia could find themselves in the news for all the wrong reasons unless they grasp their new public relations role, as Alisdair Stirling explains
The challenge ahead for GP commissioners is how to fulfil the Government's remit to cut costs and shift services from hospital into the community while keeping patients onside.
GPs face maintaining their role as their patient's advocate when the patient knows they are responsible for potentially unpopular service redesigns – and holding the purse strings – and this has already rung alarm bells at the BMA. Their response to October's health white paper consultation warns patients are likely to view GP-led commissioning ‘with suspicion'.
And as if the path mapped out for GP commissioning consortia wasn't already difficult enough, the Government's decision to make GPs, rather than NICE, responsible for deciding which drugs patients can receive pushes the pressure gauge right into the red.
GPs are already being dragged into rows over service closures, as can be seen from two cases currently in the headlines.
MPs in Enfield, north London, have placed GPs in the firing line over controversial plans to downgrade Chase Farm Hospital and close its 24-hour A&E department in the face of vehement public opposition.
MPs Nick de Bois, Andy Love and David Burrowes have written to Councillor Mike Rye, chair of Enfield Council's health scrutiny panel, asking him to ensure the plans have been sufficiently approved by local GPs.
And in Salford, campaigners hoping to save the Hope Maternity Unit are lobbying supporters to pressure the LMC into opposing the closure. And local online newspaper the Salford Star is encouraging readers to ‘Dog your Doctor'.
The paper is asking patients to:
• Ask if your doctor supports the campaign to Keep Hope Maternity Open.
• Ask your doctor why their organisation, the LMC, is supporting the closure of Hope.
• Ask your doctor to put pressure on the LMC to reverse its decision.
NHS South Gloucestershire avoided a similar situation recently by using partnership with the public to deal with the potentially tricky public relations surrounding their new community healthcare facility. The facility is planned for the site of the Frenchay Hospital, despite public outcry and a high-profile campaign over acute services moving from the site.
Dr Andrew Havers, PEC chair of NHS South Gloucestershire, said the plans would bring more services into the community, but the difficulty they faced was how to make the story positive – highlighting the new services – rather than the focus being on acute service changes and reduced bed numbers.
The PCT recruited a project board with half the members from the local community: ‘We had local politicians campaigning on a "Save Frenchay Hospital" election platform, so we gave the public 50% of the new project's steering group and got them on board instead of briefing against us,' he said.
The board's rules of engagement included the following clauses:
• Differences of view will be aired in meetings and Chatham House Rules apply (for individuals, rather than organisations) – that is comments are reported in minutes but not attributed to individuals except by agreement.
• The board and its members speak as a board. Members agree at the end of meetings how differences will be handled in public. Press statements by any organisation/individual should be agreed in advance with the board.
Dr Havers said final plans had now gone through the scrutiny committee. ‘On the Frenchay site there will be 64 beds, a variety of community-based services and sufficient land for a GP practice should it be needed in the future.
‘Consortia are going to face more and more of this. The priorities of the coalition government in terms of saving money and moving services out of hospital and into the community are likely to cause some difficulties of this sort.
‘You certainly want to avoid ill-informed and unhelpful dialogue in the pages of the local press and if you get a group of people who feel they are part of the decision-making process, you can take them along with you,' he said.
Dr Chris Peterson faced a media storm three years ago when Channel 4 News claimed GPs were lining their own pockets at the expense of patients.
GPs were referring NHS dermatology patients to community-based clinics run by a new private company in which the GPs themselves held shares. Dr Peterson was clinical adviser and had resigned his shareholding before taking part in the interviews of bidding organisations.
The PCT's legal advice said Dr Peterson's position was sound and the PCT was able to quell the media furore, but he feels there are lessons to be learned – especially with commissioning consortia potentially being allowed to provide services as well as commission them: ‘Many of the GPs closely involved in commissioning will have had a role in provision of some sort too, which makes it especially difficult.
‘Obviously, you must be as open and transparent as you can. And with hindsight, if anyone has any stake in a provider, they must stay as far away as possible from the decision-making process as they can from an early stage. Having said that, some of the things that were said in the press about us, we felt were flat wrong. And it's difficult to know what you can do about that.'
Sue Broome, director of communications and marketing at Londonwide LMCs, believes as new organisations GP commissioning consortia will have to work hard to keep public opinion on their side and will need professional help to co-ordinate their media strategy.
‘Reputation management for consortia is going to be crucial. The message is do not ignore the importance of strategic communications. You'll need expertise and guidance. If it comes down to writing a response to a headline, you are already on the back foot. You have to think of pro-active relations with the media and with stakeholders as well as "crisis comms".'
‘You need to develop messages to explain why you've made your decisions and what you are trying to do to improve services. You also need to be aware of the unintended consequences of decisions. And that goes for communicating with local authorities, patient support groups, HealthWatch, LMCs, other GPs and the voluntary sector as well as the media.'
‘Don't confine your communications team to a Portakabin. You need your leadership sitting with them at the table.'
‘GPs need to remember every decision has communications and reputation consequences. Successful organisations recognise the value of good communications. And it's no good leaving communications to someone with communications in their job title. The philosophical vision has to be shared right through – top, bottom, sideways, up and down.'
‘Corporate communications is not like Absolutely Fabulous – it's an essential management component.'
Ian Keeber, head of communications at Nene commissioning, says GPs need to think at the outset how their activities will be perceived by the public: ‘When I'm working with my colleagues on developing new pathways I push them into thinking about the risks, what could go wrong and how would it be interpreted by someone who wasn't on board. It's also about doing things in the right order. I've heard people say we are going to close a service but it's going to be replaced by another in six months time. You need to make sure that new service is in place so you can do impressive PR around it.'
Sue Broome stresses early engagement with local stakeholders is important: ‘GPs, local politicians and patients all live in the same area. So there's a real opportunity for them to get round the table early on. It's going to be extremely hard work. But failing to do that is where you'll get difficulties.'
Consortia should consider all available media when planning their communications strategy, Sue Broome says: ‘You've got to decide who you want to communicate with, when and how and use all the different channels available to you.'
‘Local authorities already have well-established local newsletters, which is one potential vehicle. Organisations such as charities also have newsletters and websites, so use those too. And don't forget Facebook and Twitter.'
‘People's opinions are formed rapidly nowadays so you have to be nimble, light of foot and totally transparent. In the old days news travelled over the garden wall. Now it's via 140 characters [in a Tweet], via the letters pages or the local radio phone-in.'
‘Speed and skill are of the essence and to move quickly, you must have the infrastructure in place.'
Alisdair Stirling is a freelance journalist.When dealing with the press, anticipate questions.