1. Think small, think big – the role of the PPG East Lancashire practice managers’ forum 2 October 2014

2. A bit about us PCC works with commissioners and providers to improve learning and skills Focus on primary care Events, workshops, programmes of support Not for profit

3. Our credentials National experts in primary care contracting and commissioning Links with DH and NHS England, eg patients and information directorate Working with CCGs, practice groups, primary care providers, LPNs, local authorities

4. Free resources Weekly newsletters –PCC News (Commissioning) –PCC News (Practice Management) –NHS Networks Weekly News Commissioning Excellence NHS Networks www.networks.nhs.ukwww.networks.nhs.uk PCC website www.pcc-cic.org.ukwww.pcc-cic.org.uk Smart guides to engagement http://www.networks.nhs.uk/nhs-networks/smart-guides/ http://www.networks.nhs.uk/nhs-networks/smart-guides/

5. What you told us You’re doing a great job Most East Lancs practices have a PPG Many of you feel you could still do more You’re an honest bunch

7. How much does this matter?

8. Role of your group (1) Health promotion Awareness of services Give patients a voice General information giving and discussion Information gathering, feedback, suggestions Agree changes to services

9. Role of your group (2) Fund raising Support local commissioners Discuss NHS topics and issues Education Improve the surgery A lot of different objectives Few practices mentioned three or more

10. Two thirds “good” or “excellent”

11. More than half only tell patients about changes “sometimes”

12. 9 in 10 say patients don’t need involving in everything

13. Problems (and what would help) Struggling to engage virtual group Little interest from patients in engaging with us Younger people won’t engage Difficulty signing up members Keeping it going – we’re a small practice A template newsletter covering NHS issues and developments that could be personalised for local use

14. Policy context Statutory duty to consult and involve patients and the public in decisions about –Services –Their own care ‘Citizen participation and empowerment’ a top priority of NHS England’s five year plan – Everyone Counts: Planning for Patients 2014/15 to 2018/19, December 2013 Commitment to personalised and responsive care Transforming Participation in Health and Care (NHS England guidance), September 2013

15. GMS contract 2015/16 - highlights End of the PP DES Patient participation will be part of core funding Named GP for all patients Online appointment bookings Online access to medical records Enhanced services: –Extended hours (eight to eight opening) –Avoiding unplanned admissions Lots of detail to come and unanswered questions

16. The big picture Low economic growth until 2020 Pressure on funding Ageing population Persistent health inequalities Rising demand across the NHS Bigger role for primary care Critical shortage of GPs Growing workload Rising expectations of quality (CQC) and safety (Francis) Prospect of political change

17. Answers? Primary care at scale (federations) –Share management expertise –Economies of scale (back-office costs, procurement) –Pool clinical expertise –Multi-disciplinary teams –Strength in numbers –Bid for new services –Address population health issues Vertical integration (hospitals running primary care) Pooled budget for health and social care More £ but more is not the same as enough

18. Why participation matters It leads to better decisions based on better evidence and built on public support Service changes made without patients’ knowledge and consent will be unpopular or could be challenged Service changes made with patients’ experience and involvement are more likely to lead to –Better outcomes (clinical, experience) –Value, best use of resources –Quality and safety ‘No engagement, no CCG’ – Brian Fisher, GP and former engagement lead for NHS Alliance

19. Participation means…(1) Patients more involved in decisions about their own care Self-care and support networks Decisions about service change Better information to help people –Stay well –Make better choices about their care –Make more appropriate use of NHS services

20. Participation means…(2) Responding to the patient’s experience –Was I treated well? –Did I get better? –Was it safe? Including everyone Transparency (patient records, GP earnings, F&F ratings) Talking, listening, giving people a say

21. Why we need to do it Statutory duty, contractual responsibility Moral duty Common sense Business sense

24. The NHS calls it… Engagement Involvement Patient-centredness Participation Empowerment Collaboration Consultation

25. In the outside world it’s… Listening to customers Giving them what they want

26. What makes something engaging? Interest Self-interest Prospect of a benefit or outcome It’s fun It’s challenging It makes you feel good It makes a difference

27. Different kinds of participation ComplaintsVoluntary sectorFocus group PraiseCondition specific groups Patient experience measures Social mediaConsultationInformal feedback Community groups SurveysPrint and broadcast media Patient groupsRating systemsInternet

28. Not everyone makes it to the top

29. Thinking about your patient group What is it for? What difference does it make? What do patients get out of it? What does the practice get out of it? Do we have realistic expectations? What could we do better? What can’t we do? What could we do better together?

30. National Association of Patient Participation

33. St Lawrence Surgery – Worthing Self-care focus Events for older people Events for children (Mr Pumpkin) Evening education events –Diabetes –Hypertension –Back pain Working with pharmacist to help people manage meds Lending books about anxiety, depression Health walks Singing groups http://bit.ly/YOLi28

34. Plus Healthwatch Community groups Hospital Community services Other providers Voluntary sector COMMISSIONERS – CCG, NHS ENGLAND, LOCAL AUTHORITY, HWB FEDERATION PPG Engaging as a system – who does what?

35. Big engagement – challenges Co-ordination Information flows Resources Sharing information Transparency and accountability Organisational and cultural barriers Responding to local/individual needs

36. Big engagement – opportunities Democratic accountability Representation Best use of resources Better informed commissioning Commissioning leverage Joined-up provision Whole population focus

37. Small engagement - challenges Resources Workload Scale Expertise Representation Sustainability Commissioning leverage

38. Small engagement – opportunities Local population focus, relevance Address local issues and health concerns Individual voices heard Draws on strengths of general practice

39. It’s not big or small North Staffordshire Insight model Focus on information for commissioners Underpinned by participation and representation from practice to CCG

42. Top tips Go where people go (they won’t always come to you) Tap existing sources of engagement Be engaging, eg curry nights for weight management Work together to solve problems Ask people how they want to participate Embrace social media Share and celebrate success

43. Discussion (1) - building on success Working on your tables come up with three examples of each of the following to share with the group Changes made by your PPG that have improved services for patients Actions taken to recruit and retain members Examples of successful health promotion, education initiatives

44. Discussion (2) – what would help you Group discussion to identify what could be done to support practices to run PPGs –Think about training needs –Think about what could be done once and shared by all

45. Further questions (1) Q1What practical support would help us run a better PPG? -Think about what the CCG could do to help -Think about skills you need Q2 How could we work more effectively as a group? -Think about what could be shared -How would we benefit? Q3 How do we increase engagement? -Think about how you keep the group going -Think about the offer to members

46. Further questions (2) Q4 Do we have a clear remit? -Does it cover the right things? -Are PPGs different by accident or design? Q5 What’s the return on investment? - For the practice, for patients - How do we demonstrate value/achievement? Q6 Who sets the agenda? -Do we do enough to involve patients in decisions? -How do we increase members’ sense of ownership?