Public and patient engagement(PPE) is playing an increasingly important role in healthcare. Not only does it provide commissioners and providers with information to help shape local services, but it provides patients and taxpayers with an opportunity to be involved in decisions about care .
The NHS Act 2006 already places a statutory duty on all NHS organisations to involve patients and their representatives in decisions about services. Under the Health and Social Care Bill's proposals, all new CCGs are expected to have an approach to engagement in place before achieving authorisation by the NHS Commissioning Board.
The experiences of some pathfinders that have already made headway on local PPE plans suggests that while successful engagement requires some effort to get up and running initially, once established it need not add significantly to workload. Participants in a recent NHS Confederation round table discussion on engagement felt significant commitment to PPE already exists within many CCGs.
The approaches used to date by the NHS all require an investment of time, capacity and money to be successful. And depending on the level of management allowance made available to CCGs, there may not be sufficient resources for all commissioning groups to undertake extensive engagement work in relation to every aspect of their commissioning activities. Possible solutions to this problem include undertaking PPE work at a ‘federated' level across several CCGs in order to make it cost effective, drawing on any available PCT cluster resource, being innovative and entrepreneurial in identifying other funding locally or nationally and/or using local existing groups.
GPs new responsibility for commissioning means they will have to consider issues on a wider scale than the traditional practice footprint. They will be planning for whole communities, not just individual practice populations and these communities will be greater than the sum of individual member CCG practice lists. They may also include groups that are not at present well-represented in engagement exercises, and patients who are not registered with a GP or people who are not themselves receiving treatment.
In addition to existing practice-based patient participation groups, commissioners can make use of community-based organisations such as Local Improvement Networks (LINks), third sector organisations, certain existing local authority schemes used to inform strategic planning, and in the future local HealthWatch bodies and Health and Wellbeing Boards. Foundation trust memberships may also provide a route to engagement, but commissioners will need to interpret their views within the context of members' affiliation to their foundation trust.
Regardless of the approach to engaging with communities, there are a number of factors to be considered if PPE work is to be successful. Most importantly, leader-level support must be present in CCG organisations, along with an understanding of the benefits that engagement can bring. Clarity of purpose is also vital - people will not want to get involved in a time consuming process unless they are clear about what it is setting out to achieve. Engagement requires time and effort, so the commitment should not be underestimated but experience suggests it does ultimately reap long term rewards.
Patient and public engagement must be at the heart of planning, commissioning and delivering care in the 'new world' NHS. Without it, CCGs will find it more difficult to deliver the large efficiency savings required and to design services tailored to suit the needs of the local community. The support of patients will be critical when difficult decisions, such as those concerning the reconfiguration of services, have to be made.
David Stout is deputy chief executive, NHS Confederation
