Last reviewed 14 November 2017

In this feature, Dr Thoreya Swage, healthcare consultant, provides some tips on how to rejuvenate your Patient Participation Group and help it to be more effective in improving services for patients.

Patient Participation Groups (PPGs) have been a feature of general practice in various forms since the early 1970s. The aim of PPGs is to provide a mechanism, feedback and review of primary care services, and enhance patient education on specific health matters.

However, despite this, GP surgeries are finding that PPGs are falling short of what is required of them and in some cases have become a burden to the practice.

Background

To boost patient engagement in April 2011, NHS England made available extra funding to practices for having a PPG through a Directly Enhanced Service or Locally Enhanced Service Contract. As a result, many “tick box” groups were formed to meet this requirement without any clear purpose or structure apart from undertaking an annual survey.

The effectiveness of these PPGs was dependent on the engagement of the practices (eg involvement of the doctors or practice manager) or the patients who formed the committees.

The requirement for patient engagement was strengthened in April 2015 by PPGs becoming a contractual obligation for all English practices. In addition, it was expected that reasonable efforts would be made for the PPG to be representative of the practice population.

Since then, further modifications have been added such as involving the carers of registered patients who themselves are not patients registered at the practice and for the practice to engage with the PPG in obtaining patient feedback and, where the practice and PPG agree, to act on suggestions for improvement. This engagement is tested by the Care Quality Commission (CQC) on their inspection visits.

However, using the patients registered at a practice to form PPGs means that there are other patient groups who will miss out, eg those who are not registered such as the homeless, refugees and asylum seekers.

What are the benefits of PPGs?

A well-functioning PPG can benefit both the patients of the practice and the practice itself.

For patients, a PPG:

  • provides a forum to raise issues and recommend improvements to services

  • enhances the understanding of patients of how the practice operates

  • improves the understanding of patients about the workload of the doctors and practice staff

  • enables patients to look after themselves and their families.

For the practice, a PPG:

  • can enhance communication with patients

  • enhances the relationship between staff and patients

  • improves patient engagement and provides support for the practice’s aims and objectives.

How engaged are the patients in my practice?

Patients and carers are a valuable resource in health and social services, however, they do not necessarily appreciate how helpful they could be. Patient engagement is enhanced if people feel that their views are respected and valued and that they are making a difference. Some will be motivated by a need to fill a community role, while others will want to engage because of personal or family experiences.

Patient involvement in healthcare can happen on many different levels. Patients can choose how much (or little) engagement activity they decide to undertake. There is no single trigger although it is possible to test the level of engagement by asking a few questions in patients’ own care. So, for example:

  • do patients look after themselves as best they can both physically and emotionally

  • if patients have a long-term condition, are they activated to self-manage and if so, do they seek help to improve their skills to self-manage

  • do patients have a care plan and share it with everyone involved in their care

  • have patients made an End of Life plan or advance directive?

At the practice level:

  • do patients give feedback on their care — good, bad or indifferent

  • do patients respond to a survey or newsletter

  • are patients a member or are they interested in joining the PPG?

These questions test the level of patient engagement and this could be enhanced through an effective PPG.

How PPGs are functioning now

Given that there has been little guidance on how to set-up PPGs and a lack of clarity on structure and role, it is unsurprising that some of these groups have become dysfunctional. Groups have formed that spend much of their time complaining about services to the practice manager or GP who attends the PPG meeting; preparing and writing notes for the PPG has become the role of the practice manager and the outcome is frustration on both sides with little achieved as a result. Monitoring of the effectiveness of PPGs has been limited.

PPGs are also described in a number of different ways, eg Patient Participation Group, Patient Practice Group, Patient Reference Group and many other names that have been chosen locally which adds to public confusion.

How can my PPG be rejuvenated?

Successful practices have been shown to have effective patient groups resulting in mutually positive outcomes. An effective PPG can be a good ally and a key in supporting the practice in the submission of bids. It can also mitigate the conflict of interest issues in the extra services the practice may wish to tender for.

If a practice has a PPG but it is not meeting the needs of the practice then it is necessary to examine the dynamics and skills of the group.

In a dysfunctional PPG often the key members have been on the group for a number of years. They may be resistant to ideas or requests from outside and cover the same topics again and again. In addition, if the organisation (including drawing up the agenda and writing up the notes) of the PPG is down to the practice manager the group does not own any of the issues discussed. If this is the case then it is worth considering disbanding the group and starting again.

This, of course, needs to be communicated and managed sensitively.

Actions to consider

When refreshing a PPG a number of actions can be considered.

1. Look at the practice profile and consider targeting patients who are more representative of the practice population. Members of the practice team including reception and admin staff, practice managers, practice nurses or doctors can ask individual patients on an opportunistic basis if they could get involved in the PPG. Alternatively, the practice can hold open meetings, or create an email list of patients willing to give their views electronically, or select a random group of patients to ask if they would join the PPG.

2. The key roles in an effective PPG are the Chair and Secretary. It is helpful to draw up role descriptions for these positions specifying the expectations of the person and the practice. Set a time limit on how long the Chair and Secretary should be in post, eg one or two years with an ability to re-elect to the post. Working this way ensures fresh views come into the PPG and prevents the group from becoming stale.

3. Having well-defined terms of reference or constitution, and clear agenda or action plan with specific outcomes keeps the PPG focused and relevant.

4. Prior to re-setting the PPG it is helpful if other roles or sub-groups should be considered, eg communications (such as newsletters, notice boards, website, social media) or engagement (face-to-face/networking/surveys/education events).

5. One of the ways to re-set the PPG is to centre this around a project, eg an educational event or buying a piece of equipment that the surgery needs. Using this approach targeting patients with specific skills, eg marketing, finance, conference organisational skills, human resources, etc, ensures a well-executed project. By having a time-limited project, this makes the likelihood of successful engagement greater and, with this, a better chance of identifying more involved patients for the group to tackle other projects.

6. Some patient groups may welcome an opportunity to get involved in the practice. For example, the local further education college may have a health or social care course. Students may find it helpful to their studies if they were able to conduct a project related to the practice and the latter benefits from a piece of work well executed, eg a survey.

Alternatively, an unemployed person may find that their involvement in a project in their local practice bolsters their CV and increases their chances of finding work.

7. Developing the PPG through access to training can make the group more effective. For example, training through organisations such as the local NHS Leadership Academy, Healthwatch, NHS England, Academic Health Science Network, etc will help patients understand the NHS so that they can provide the right level of involvement and are informed enough when difficult decisions are being made.

Examples of how effective PPGs can be

Well-engaged patients can provide great support to practices in their delivery of patient care. Below are some activities that PPGs have done in this regard.

Within the surgery, PPGs:

  • can conduct waiting room surveys including Friends and Family Test questionnaires on behalf of the practice. This is an opportunity to increase the response rate as well as educate patients in the waiting room about the services provided by the practice

  • can write and distribute the practice newsletter. It is important for the practice to have an overview of what is being written on their behalf otherwise there may be some conflicting messages

  • do the practice notice board. Again a consistency of messaging is important

  • promote health checks and other regular vaccinations (eg flu jabs, etc)

  • run open mornings either within the practice premises or elsewhere to explain the services the practice offers, provide a forum for patients to discuss health or social care issues, or to educate patients about various long-term conditions

  • provide feedback to the practice as part of the staff appraisal process

  • support the practice in CQC and Healthwatch Inspections

  • support the practice in planning applications with NHS England.

Outside of the surgery, PPGs:

  • can provide training to patients on how to access practice online services such as repeat prescriptions or appointments. This training does not have to be in the practice. This could be done in another place where there is access to computers such as a public library

  • may have links in the community which can be used to support service delivery, eg voluntary organisations such as Age UK or other pressure groups which can help support change

  • can provide peer support, for example through the running of community coffee mornings. These can be in conjunction with voluntary sector organisations such as Cancer UK, Diabetes UK, Alzheimer’s Society, etc and have a double benefit of raising funds and reducing loneliness. The latter could then have a knock-on effect of reducing the pressure on GP appointments

  • in one area, a CCG has developed the concept of “Health Makers”. These are patient self- management courses organised and run by the PPG with the help of local consultants and sponsored by local companies. Various topics such as asthma, diabetes, arthritis, etc have been covered

  • in another area, members of the PPG have secured the use of parking spaces in the driveways of local residents for the use by practice staff during the day while the occupants are out at work. This then releases the practice parking spaces for the patients visiting the surgery

  • have monitored the use of social media with respect to their practices, specifically by explaining what the practice is trying to deliver and through positive support of the local surgery.

Many more examples are provided by the National Association for Patient Participation.

So through a little creativity and support it is possible for a PPG to support its practice and enhance service delivery.