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CCGs strain to hear voice of patients
CCGs understand the need to engage with patients but questions remain about their ability to translate good intentions into effective plans and to hold their nerve when unpopular decisions need taking.
These are among the findings of a new report based on interviews with 18 people from six CCGs including the clinical lead (usually the chair), accountable officer and lay board member.
Commissioned by the Department of Health for the NHS Commissioning Board, the study* found a high level of awareness and enthusiasm for the principle but underlying anxieties about PPE in practice.
The report’s authors deliberately talked to CCGs in the second and third waves of authorisation to get a picture of the average. They found most of the sample able to produce examples of engagement initiatives targeted to particular conditions (for example dementia and HIV) or around particular services (for example urgent care). They also found CCGs starting to have “productive discussions” about investment priorities and the need for service change.
These examples should not be mistaken for what the report calls an “embedded engagement culture”. Acknowledging that CCGs are still barely formed, the report expresses concern about the “few specific examples of PPE in the authorisation process” and the lack of involvement of lay members. Only one of the CCGs had involved a lay member in the authorisation process.
Despite signs of engagement activity, there is less evidence of shared understanding and “a lack of understanding about what it might mean to be ‘patient-focused’ or ‘patient-centred’”.
The report also raises questions about whether CCGs are engaging people at the right time. Engagement tends to be concentrated on the middle phases of the commissioning cycle (planning and service design), but should start earlier with “needs and aspirations”, the authors suggest. Similarly, patients and the public could be involved in the later procurement and monitoring phases of commissioning, allowing them to influence the choice of provider and the quality of the service.
The report found evidence that some CCGs see potential for conflict in their roles as patient champions and effective commissioners. “Many…aim to be responsive ‘listening organisations’. This does not always sit comfortably with the need to make tough commissioning (and decommissioning) decisions.”
The report’s co-author Andrew Craig of Moore Adamson Craig Partnership, said: “These CCG leaders know that embedding engagement in everything they do is essential if they are to make commissioning decisions and service changes with broad user and carer understanding and community support.
“They are hungry for metrics to measure the impact of their engagement efforts. With the right support and encouragement they should quickly become local organisations that listen and engage well.”
Interviewees acknowledged concerns that patient participation groups (PPGs) were not representative of the wider population and related concerns about their ability to scale up communication to large numbers of people. The authors concede that these groups may be the “primary building blocks” for engagement, but point out that CCGs have yet to tackle the problem of how to use PPGs as part of bigger engagement structures.
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