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Harnessing the patient resource

Helen Northall wrote encouragingly in this month’s edition of Insight about informing and engaging patients. I agree with her.  But as a PPG chair, I think this can be taken one step further.

Mike Etkind

The last year has shown how much appetite there is in communities to help out.  Whether it is volunteering via RVS and the national scheme;  setting up local Facebook groups to coordinate neighbour support with eg shopping prescriptions;  organising a bank of volunteers to help out at vaccination sites;  or just neighbours in a street looking out for one another.

It may be that some people at present have more time on their hands than before, but I suspect Covid has also shown there was always a latent volunteer resource on top of those who already offer their time to their community. And what can be great is that, as well as providing help to others, the people who have put themselves forward have probably themselves benefited: whether it is by simply filling time on their hands, or by feeling useful, or more generally by boosting their mental health and wellbeing. Indeed, getting more people involved in volunteering may amount to a form of social prescribing.

I am sure Helen is right in stressing the importance of engaging with patients and communities so they are more on board with how their practice is now operating, they understand the pressures, and their patience is hopefully better. (Indeed, I would support more training being offered to practice managers in patient communication: both in terms of technical options and patient friendly messaging.)

But, for me, it should be not just about practices communicating outwards to patients, but two-way communication and a two-way relationship which creates a community of patients and the whole practice team. And such a dialogue is more than the blunt instrument of patients occasionally being asked to rate the likelihood of recommending their surgery on a scale of 1-6. Or, equally blunt, patients being sent a text simply asking them not to contact the surgery about vaccination – sit tight and await your turn. Both keep patients at a distance.

I think the way to start is probably with having a fully engaged and embedded PPG. This will potentially offer to a practice a number of benefits. The committee members may have skills they are willing to offer to the practice. The committee is likely to have other patient contacts or mechanisms to recruit volunteers, access skills, and pick up on local vibes which might inform a practice’s communications. And the committee will be able to offer a patient perspective – in the context of Covid, both in terms of understanding the anxieties people have and the sorts of things that people would like to know to reduce those anxieties.

In addition, messaging about practice pressures and the need to be patient may be better received if delivered by fellow patients rather than the practice. And patients who are bought into a practice via volunteering, and feel their efforts are valued by the practice, may be more likely to be cheerleaders for the practice in the local community and have a role in boosting morale among the staff.

So, as an alternative to the ‘sit tight and wait’, a PPG suggested to the practice that if patients had more information about which groups should expect to be vaccinated when (including, importantly, being up-front about the uncertainties), as well as clear advice about the different ways they would get a jab invitation and different places that might be offered, they might be less anxious and ring the surgery less often. The suggestion included texting the 90% of patients contactable by SMS to ask them to read the website first and saying it would be updated frequently. This was done, the website was updated two or three times a week. The number of phone calls went down.

And to boost morale, a surgery monitored local Facebook and passed on a series of favourable comments to the practice. It also sent regular supportive messages, including a message with a virtual bouquet of flowers which the practice put on its website.

It is important also to recognise that greater involvement of patients will not be entirely plain sailing.

First, it may need a bit of effort from the practice to kick-start things before recouping the benefits. Whether that is to identify patients likely to be able to offer constructive support who might be interested in joining the PPG. Or to prompt the PPG by identifying the sort of things that they could helpfully contribute. And I know that not all practices have anything more than a so-called virtual PPG, or find it difficult recruiting enough patients capable of contributing in the way I describe above.

Second, there is the issue of the mindset of the practice. Do the GPs and practice manager see it as an important deliverer of services to patients or with patients? Do they see the practice as a key local provider or an integral part of the local community (or both)? We already have shared decision-making in relation to managing conditions, why not also a little of this in relation to managing the service as a whole? (I know GP practices are also businesses, but businesses have non-executive directors; although I’m not pushing this particular model, just the principle of independent engagement.) Perhaps the increased emphasis on integrated health and social care and on patient self-care will help break through such cultural norms where they exist.

Third, PPGs are intended to be critical friends. But there are some PPGs whose activities perhaps pay more attention to the ‘critical’ over the ‘friend’, and who might be more likely to prompt more impatience rather than less. I can understand a little wariness over this potential issue.

So, Covid has perhaps reinforced that there is scope in primary care to alter perspectives: the patient community as a potential part of the solution not just grateful consumers of health services.

Mike Etkind, chair of a PPG and founding member of his PCN’s patient group.