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Crunch time for patient involvement

There are new challenges for primary care, which could really do with patient input. Mike Etkind, chair of a PPG and founding member of his PCN’s patient group, recognises the size of the task clinical directors have managed over the last few months but identifies two particular issues where patients have a necessary and valuable contribution, that need to be addressed now – the 2020 vaccination programme and primary care from a distance- total triage, remote consultations, and the use of telemedicine.

Mike Etkind

Eighteen months ago I wrote an article in PCC Insight about whether patients were being involved in setting up and running PCNs. I’ve seen a few tentative steps forward, but nothing that could be described as co-design or co-production. Now there are new challenges for primary care, which could really do with patient input.

The only reference to patient participation in NHS Confederation PCN Network’s One year on report is a quote from a clinical director (CD) that they “are still firefighting and have no opportunity to increase patient participation”.

It would be foolish not to recognise the size of the task CDs have and that engagement with patients hasn’t been the top of the list since the pandemic hit. I don’t say that patient engagement was impossible during lockdown, but I can understand that it got lost among many other priorities.

However, with apparently more and more instructions and directives hitting GP and practice manager desks since lockdown began, perhaps they can now sympathise more with patients who want a say in what and how their primary care services are delivered.

Moreover, Covid has shown how valuable community action can be in a crisis (in some cases at PCN scale) – something that might be built on in PCN’s intended role as being a local focus for bringing together all parties involved in healthcare and social care at local level.

At the time of writing, there are two particular issues where I believe patients have a necessary and valuable contribution.

2020 vaccination programme

My first issue is short-term: how to make this year’s flu vaccination programme work and maximise numbers vaccinated. GPs face not only the constraints of social distancing, but also the addition of 50 to 65 year-olds swelling the ranks of those eligible. Doubtless there are other issues I’m not aware of.

I’ve spotted that at least one PCN has been working up a plan to deliver a single vaccination programme for all its member surgeries. I guess many surgeries are holding fire on their final planning in expectation of central guidance on how to manage the process.

From a patient perspective, what options are likely to make us more likely to go for a jab? Has anyone asked? Will patients feel safer and be more likely to attend an outside venue, perhaps with a drive-through facility? Or will use of the surgery with a one-way system through their existing building attract just as many? How accessible is the proposed venue? Will vulnerable patients be treated differently – bigger gaps between slots or whatever? How will patients reach the venue: easy access by public transport would have been a consideration, but does thinking need to be altered if some patients are now wary of using public transport? Maybe temporary vaccination venues at more than one location in a surgery’s catchment area would be helpful as a way of minimising travel?

The breadth of any patient engagement may have to be limited by time and resources. But at minimum a surgery’s PPG may be able to offer some insights, even if surgeries’ options are ultimately limited by central guidance.

Primary care from a distance

This second issue is medium and long-term. It seems pretty certain that Covid driven developments such as total triage, remote consultations, and use of telemedicine, are to a greater or lesser extent likely to be here to stay.

As far as I can tell, patients have largely embraced the changes since March. Needs must; and for many, these new arrangements may be seen as an improvement over the ‘old normal’ as well as perhaps encouraging greater self-care. But what is the range of views about these arrangements maybe becoming permanent?

We already have an insight report from National Voices and Healthwatch*. This seems a valuable early contribution to patients’ experience and it calls for a ‘blended’ approach to meet the needs of patients.

Patient needs and wishes will vary and I believe even those who are positive about the changes are likely to have questions. These should be invited and welcomed as a help in designing future systems. And, if taken seriously and responded to, may help give all patients some reassurance that things will work for them. Questions like:

  • Will GP face-to-face appointments become such a rarity that patients, particularly those with long-term conditions, will lose the relationship with a particular doctor?
  • How does remote consultation or use of apps work with those with learning disabilities or dementia…?
  • How do you check remotely a possible ear infection in a child or the feet of someone with diabetes or something intimate…?
  • Do we need to be wary of over-medication because GPs feel the need to cover themselves more when not seeing a patient face-to-face?
  • What help – financial or technical – can we expect if we are now going to be invited to get our own blood pressure monitors or to use apps to manage our condition?
  • Will I find different approaches if I ‘see’ different health professionals in my PCN?

Most of what I’ve seen written about the ‘new normal’ in primary care focuses on the technicalities and what is achievable and what works for the healthcare system. In order to bring patients of all sorts along with the changes, we need to be informed, involved and engaged. No-one wants to be talking in the next few years about how the major shift in delivering primary care disadvantaged the less robust in society because patients were not at the heart of things.

Since writing this article in July, Mike’s PPG has completed a survey to get an early understanding of patient reaction to the Covid arrangements his surgery put in place. The resulting report can be found at https://www.johnhampdensurgery.co.uk/ppg.aspx