Anya de Iongh: What opportunities do primary care networks present for patient partnership?

When we use healthcare services, the chances are that our contact with the NHS happens in primary care. In fact there are over 300 million GP appointments each year. While we may never, or rarely, use other NHS services, seeing a GP is a common thread for everybody. So in the context of primary care, we really are “all patients” to some extent, at some time in our lives, and we have a stake in what that means to us. The patients making up a practice list are far from homogenous. They will each have different priorities for access or continuity of care, and preferences for support for long-term health conditions or other health needs.

Given this, a population approach makes sense. This is behind the latest innovation in general practice—primary care networks (PCNs). The vision for primary care networks has been articulated in the NHS Long Term Plan and recently in the framework for GP contract reform. Whatever changes are precipitated by this new infrastructure, if they are to work for their local population, they need to be made with their local population.

This scale and scope of primary care as a whole makes patient partnership and citizen involvement fundamental in so many ways. The resources to enable this can be hard to muster for individual practices beyond patient participation groups (often called PPGs, which vary a lot from surgery to surgery). Part of the rationale beyond networks is to benefit from economies of scale of a 30,000 – 50,000 population. Those benefits should extend to resourcing patient partnership and citizen involvement. Disappointingly patient participation groups or other forms of patient partnership were not mentioned in the framework, even though the successful and sustainable implementation of many of the components of the new framework will rely on meaningful patient partnership and citizen involvement.

The roles that patient participation groups fulfil in surgeries varies in terms of form and function, as well as impact. So what opportunities does the new landscape present for patient partnership and citizen involvement, through existing patient groups or or other ways?  

One role could be to support and localise the link worker role for social prescribing, as well as the other components of personalised care as they are developed. The principles of supporting people to be active partners in their own care is aligned with the principles of co-production and involvement at a service or community level. To be truly personalised, these services need be co-produced.

Another might be guiding the communication of and engagement with new digital access services that the framework specifies. Like other initiatives that these primary care networks will be “rolling out”, these are nationally mandated, so the argument is that they are a fait accompli. While true to some degree, it is the detail of how they work locally and how they are communicated to patients which is so crucial. A new care pathway that includes an app, digital service, or even a new professional such as first contact physiotherapist requires awareness, understanding, and a shift in expectations and behaviour for patients. If these steps are taken in isolation to patient perspectives, they could be setting up these initiatives to fail before they have even started.

The inclusion of quality improvement in the Quality Outcome Framework is another opportunity. The role of patients and carers in quality improvement is already well discussed, but hasn’t been explicitly mentioned in the framework. Much QI focuses on shared purpose, and then identifying the problem—both of which risk being incomplete without patients as partners throughout the process.

Lastly, and more broadly, Primary Care Networks have more scope for commissioning and developing services through their allocated budgets. It is now well established that all stages of the commissioning cycle benefit from effective patient partnership—from establishing need, to designing solutions and reviewing the impact. The fact that this funding comes from the public purse adds a further ethical imperative to the case for investing in and committing to meaningful citizen involvement.

With the rush to form and formalise primary care networks ahead of national deadlines, I would be interested to hear how many practices have been informing their patient participation groups and patients of these changes? The ladder of involvement starts with informing, but it is far from unreasonable to expect co-production in these early stages. In fact, it is widely accepted that involving people early on is really important—lets not leave it too late.

The potential offered by primary care networks is significant. There is much to welcome in this new model for primary care, and many factors that will determine their perceived success, including how much these developments are co-produced with local communities. Whatever changes are precipitated by this new infrastructure, to work for their local population, they need to be made with their local population.

Anya de Iongh is patient editor for The BMJ and works nationally and locally around person centred workforce development and self-management support services.

Competing interests: Full details here.