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A quick guide to achieving the patient participation DES

It is simple, free and easy to meet the requirements of the Patient Participation Direct Enhanced services, but doing so will bring additional revenue to every practice and – more important – powerful, effective engagement with patients supports better care, happier patients and increased job satisfaction among clinicians.

The five steps below will show you how to:

  • Set up effective engagement with your patients to meet requirements of CQC registration
  • Exceed DES requirements and achieve £1.10 funding for every registered patient
  • Develop a means of capturing and responding to patient feedback, and use this to improve your practice.


1 Set up a patient participation group (PPG) and agree priority topics

Many practices already have a PPG, although it may go by a different name. All it means is that a representative group of patients meets with members of the practice in a formal, regular and documented manner. Such meetings should be well publicised to patients, invite patients to suggest topics for discussion and debate, and make sure that all patients can access the outputs, discussions and decisions of the group.

To meet the requirements of both the DES and for CQC registration, it is necessary to show that the PPG is truly representative of the practice population, for example by age, ethnicity, gender, social class – or at the very least full efforts have been made to ensure you’re aligned to the demographic.

It is sometimes suggested that the PPG can be ‘virtual’ or online, but I would strongly counsel against such a route.

While this might look like the simple route, it is only the rare practice that can confidently predict a representative PPG that is only accessible online. Many have learnt from bitter experience that maintaining interest and engagement by email with members of such a group is a frustrating experience for all concerned.

Once the group is formed, they simply need to agree priority topics and areas for the practice to improve on. All of this should be formally documented.

2 Launch an ongoing patient survey

The DES requires you to survey patients as to what they’d like done to improve the quality and service delivered by the practice. The more patients are involved, the more robust will be the data, and the more useful it will be to the practice and DES submission.

Although the minimum requirement is for an annual survey, practices asking for feedback at such an interval will struggle to gain real benefits from the process. To fully engage your patients, to ensure that they feel involved and that the practice and PPG fully understand current issues, best practice is to collect feedback on an ongoing basis from patients, their relatives and carers. This should not cost the practice any money, and only requires a little time.

There are plenty of websites that provide a free service to NHS GPs, enabling you to collect continuous feedback from all your patients – about both those who care for them, and their experience of the practice in general, for example waiting times, courtesy, efficiency, and communication.

Giving every GP and practice their own customisable webpage, which can be linked to the practice’s own website, patients simply need to be asked to visit and submit their feedback, experience and ideas. This is all completely free and the practice has full control to share this information with the PPG.

3 Report feedback to the PPG and discuss changes

Collecting large volumes of detailed patient feedback on a continuous basis can transform the interest, energy and effectiveness of your PPG. Rather than dry, repetitive conversations about a survey which might have taken place 11 months ago, every PPG meeting can start with a review of comments, experience and real patient feedback from the previous weeks. Including quantitative assessments (‘patient reviews’) enables the PPG to track detailed change over time and truly informs the decisions and priorities of the group.

The aim of course is that the PPG has robust, documented information from the largest number of patients on which to base their discussions and recommendations for changes – for example amending practice hours, altering the format of clinics and indeed anything else that is the priority of the patients.

We have all seen instances where a small number of ‘engaged’, vociferous, professional patients dominate user groups with the risk that the issues prioritised fail to represent broader interests. Enabling the PPG to base discussions and decisions on large volumes of feedback (ideally more than 400 responses from patients every month) prevents this, not only ensuring you receive your DES payment but – more important – providing the practice with a truly valuable resource to ensure that continuous improvement really does focus on matters of interest to the largest number of patients.

4 Make service changes and publicise them

As long as you’ve captured lots of feedback and comments from lots of patients, this step is very easy. Implementing the changes proposed and agreed by the PPG is straightforward and will be well received if you are confident they do represent – and will meet the needs of – many patients.

But for the DES it is insufficient to simply make the changes. To get your full payment you must share news about the changes with your patients both in the practice and online. You can do this through your existing website. Advertising the address of this page or linking to it all helps get the necessary information out to patients. For example, many practices ensure that this web address (URL) is printed at the bottom of clinic letters or reminder cards.

But remember the whole process should be dynamic and ongoing, not a once a year box-ticking exercise.

With ever more patients doing online research before deciding which practice to register with, using the internet to show that you openly and transparently seek and respond to patient feedback (‘ratings and reviews’) has a real impact on practice brand, online reputation and can help grow list size.

5 Continue to collect feedback and identify new opportunities

To ensure that your patient participation is truly dynamic and responsive, the practice – through its online and offline feedback – should continue to collect feedback from patients, use this to assess progress and to identify new opportunities for improvement.

Again, it is likely that you are doing this already – all good businesses practice continuous improvement and are always listening to those who use their services. But for the DES it is very important that you have a record of the patient feedback and involvement throughout the process. For instance, providing a log of all patient feedback is good practice – enabling you to show exactly how you sought comment, what you did about it, and how you conveyed the information back to the patients.

Dr Neil Bacon is the founder of and iWantGreatCare.