Patient participation DES ‘How to’ workshop for practice managers By Kerry Naylor, Head of patient experience

Key objectives Ensure patients are involved in decisions about the range and quality of services provided Reward and encourage practices for routinely asking for and acting on the views of their patients Publish patient feedback on practice websites

What’s the difference between a Patient Participation Group (PPG) and a Patient Reference Group (PRG)? A patient participation group (PPG) is a self-organising – group run by six to 10 patients with some help from the practice. The group decides what issues they would like to discuss with the practice, or help with (e.g. health promotion events). PPGs meet every couple of months A patient reference group (PRG) is a group set up, and run by the practice. This group is used to seek patient views by using a local patient survey. It is easier to do this as a ‘virtual’ ( ) group. It can be used to do other things once it’s well established. A patient reference group allows practices to gain a more representative view from the practice population; it doesn’t replace the PPG

Key steps 1.Set up a PRG to gain views of patients 2.Agree areas of priority with the PRG – include these in an annual local survey 3.Collate patient views through the use of survey 4.Discuss survey findings with PRG and agree any changes to services. Where the PRG does not agree significant changes, agree these with the PCT 5.Agree action plan and timescales for implementing changes with PRG 6.Publish the local patient participation report on practice website by 31 March – update with actions achieved

DES requirements DES componentWeighting of payment – year one Weighting of payment – year two 1. PRG of registered patients established20%0% 2 Priority issues agreed and included in local practice survey 20%10% 3. Patient views collated20% 4. Findings discussed with PRG and changes agreed. Where the PRG does not agree significant changes, agree these with the PCT 20%30% 5. Action plan and implementation timescale agreed 20%30% 6. Local patient participation report published and updated with actions achieved 0%10%

Reporting on practice results As part of the validation process your practice will need to do the following: Report must be completed and publicised on your practice websites by no later than 31 March Failure to publish report on your practice website by 31 March deadline will result in no payment being made Posting on to the website is your practices responsibility Payment will be based on evidence provided in the practice report that each successive component has been achieved Payment on achievement of component is dependent on previous components having been successfully completed

Reporting on practice results You must ensure that you: Outline the steps taken to gain feedback from a representative cross-section of the population Demonstrate how you have engaged with under- represented groups Show that the survey process is credible – e.g. sufficient people were surveyed for the results to be representative of your practice population

Step 1 Develop a patient reference group (PRG)

Structure of group Decide how the group will communicate. You can develop a virtual PRG, an group that can be consulted on a regular basis, and/or meet face to face You can decide on virtual or a face to face group or a combination of the two

Case study – community voices project

Community voices project Enabled four practices to setup and communicate with a virtual patient group of up to 100 patients Practices recruited between 50 and 100 patients Each practice approached the task differently depending on local time and resources Timescales varied from two days to six weeks to recruit the PRG members The majority of people who were invited to the group who had an address responded positively

Benefits Cost effective, implemented with limited support The group can help to decide how services are commissioned, planned and developed The group can be used in future as an ‘e-survey’ panel or targeted engagement with groups of patients with long term conditions

What practices found Recruiting to the PRG and running a short survey was easier than they had anticipated All practices enjoyed using the online survey tool, finding it a quick and easy to use resource Many survey tools are free, which enabled practices to trial them with no pressure to commit resources The response rate from virtual group members was 40%, which is generally regarded a good response

Recruit to your PRG Advertise in your surgery and practice leaflet Ask your new patients at point of registration Ask patients at reception or at the end of their consultation by handing out a leaflet to them Asking patients during routine surgery visits helps to reach those people who attend infrequently Ask patients who visit the surgery or give them a leaflet Use the posters, flyers and leaflets available Tip: record a specific read code for patients who have given permission to be contacted

Support pack

Getting started guide 1.Sample contact form (see pack) 2.Script for patient group members 3.Script for staff in practices with a Patient Reference Group 4.Script for staff in practices without a Patient Reference Group 5.Suggested wording for LED display 6.Suggested leaflet/flyer (see pack) 7.Suggested poster (see pack)

Making your group representative To understand your practice profile, consider: Age, sex and ethnicity date Social factors e.g. working patterns of patients Unemployment levels Number of carers Specific care groups e.g. nursing homes, people with learning disabilities

Information sources Consider practice knowledge of patients through: –Quality outcomes framework (QOF) –Prescribing patterns –Use of extended hours surgeries Office for National Statistics has local population data, LINks may be able to support practices with elderly patients or patients with learning disabilities The National Association for Patient Participation (NAPP) has useful case studies and other resources,

Step 2 Agree areas of priority with your PRG

Identify practice issues Consider: Patients’ priorities and issues Practice priorities and issues including themes from complaints Planned practice changes Care Quality Commission (CQC) related issues National GP patient survey issues Discuss issues with your existing patient participation group too

Proforma asking patients about their priorities could be developed and agreed between practice and PRG We are planning our next annual survey and to ensure that we ask the right questions, we would like to know what you think should be our key priorities when it comes to looking at the services we provide to you and others in the practice. What do you think are the most important issues on which we should consult our patients? For example, which of the following do you think we should focus on: Clinical care Getting an appointment Reception issues Opening times Parking and so on

Step 3 Collate patient views through the use of a survey

You must undertake a local practice survey at least once a year The number of questions asked in your local practice survey will be a matter for your practice and your PRG to agree Questions should be based on the priorities identified by your PRG and your practice. Questions can be taken from existing validated patient surveys subject to the necessary copyright permissions, or be developed locally A list of questions compiled from existing validated surveys is available in your support pack

Agree questions with PRG Use questions from validated patient surveys (see support pack) or develop your own – there’s no fixed number of questions Questions should be easy to understand, don’t use jargon Keep questions short ask one question at a time Avoid leading questions Avoid built-in assumptions about things the respondent may or may not know about Avoid asking things that are too general, too complex or undefined

Question types 1. Open-ended – where respondent have free text to write what they want. Pros: good to use when asking for attitude or feelings, likes and dislikes, memory recall, opinions Cons: some respondents don’t find it easy and so put ‘I don’t know’, it can take the respondent longer to fill in and can take you longer to analyse 2. Close-ended – where respondents answer ‘yes’ or ‘no’, or from multiple choice list.

Question types (II) 3. Ranked – where respondents rank what is most/least important, on a scale from Rating – is a popular way of collecting subjective data where you want to measure the ideas of a respondent (for instance opinions, knowledge or feelings). There are two types: –Create a statement and ask respondents to rate how they feel about it, for instance “Strongly disagree/Disagree/Neutral” and so on –Provide respondents with a scale, for instance from “Improved” to “Not improved” and ask them to rate their opinion on this scale.

Survey methodology Decide whether you will use a paper survey (in surgery or mailed to patients) or a free online survey tool to develop your survey Discuss survey methodology with your PRG Decide whether your practice will collate and analyse the results or to outsource this work Test your survey to make sure the questions make sense and that you get the information you are looking for

Online survey tools Survey Monkey – Survey System – Kwik Surveys – esurveys pro – Smart survey –

Information sources Further information on developing effective questionnaires can be found at:

Encourage people to respond Ask people to participate in advance Briefly explain what the survey is about, including: the name of practice; confidentiality information; how data will be used; and how long it takes to complete Make the first couple of questions easy and quick Send reminders during the survey period for those who haven’t completed the survey

Analyse results Decide whether your practice will collate and analyse the results or to outsource this work Online survey tools like Survey Monkey will analyse the results of the survey for you

Calculate response rate The percentage of people who respond to your survey is considered the “response rate.” A high survey response rate helps to ensure that the survey results are representative of the survey population. To calculate the response rate, divide the number of complete surveys by the number of participants contacted. Multiply by 100 to get a percentage response rate

Step 4 Discuss survey findings with PRG & reach agreement on changes to services

Discuss survey findings Provide your PRG with an opportunity to comment on and discuss the findings of your survey Consider any other relevant information such as themes from complaints or CQC feedback if available

Agree proposed changes Agree any proposed changes to services (e.g. change in opening hours) with the PRG If the PRG does not agree to a change, the practice must agree with NHS ONEL Changes which impact on contractual arrangements also need to be agreed with NHS ONEL

Step 5 Agree action plan with your PRG and seek their agreement to implement changes

Action plan Following discussions in Step 4 an action plan must be agreed: You must agree how you will implement any agreed changes with your PRG Steps 4 and 5 can take place at the same meeting, at separate meetings via an group, or a combination of these or other methods

Step 6 Publicise actions taken

Publish survey results and actions taken Publish a local patient participation report on your website by 31 March 2012 and 2013 Detail your opening hours and out of hours arrangements in your practice leaflet, website and in your report Link actions to feedback from patients: ‘you said… we did… as a result…’ Where actions were not agreed by the PRG, explain why the practice has decided on an alternative action

Practice websites

Developing a website Primary Care Commissioning has developed a toolkit to help GP practices meet the DES requirements. It is available as part of an annual subscription, and includes advice on how to set up a low cost website. For more details please

Example website

NHS profile To register, call the NHS Choices service desk on or Guidance on creating and editing your practice NHS Choices profile is available at

Thank you Any questions?