Good practice in transformation planning

Primary care transformation – stakeholder engagement in transformation planning

Situation

NHS England led a programme of work to evaluate the strength of London’s primary care, produce a case for change and define a commissioning framework for primary care transformation. The engagement work began in the summer of 2013 and concluded in March 2015.

There was a legal duty to involve the public as the purpose of the programme was to make primary care better for patients and the public of London, we wanted to ensure we discussed their needs and wants with them. We wanted to include the public and set up a consultation process.

Overview of public involvement activity

There have been three stages to the work:

Stage One

The team worked with various stakeholders and used a thorough set of research and data to produce a diagnostic paper “A Call to Action” document setting out a case for change for London’s primary care services. It concluded that our growing, ageing, deprived and diverse population was putting pressure on the traditional approach to general practice and there needed to be fundamental changes to the way that primary care operated. The document envisaged new models of care emerging, with groups of practices coming together with a far more important role in the coordination and provision of a wider range of services.

Stage Two

Following the publication of “A Call to Action” three expert panels (task and finish groups) were set up and tasked with creating a draft set of patient services standards – later to be described as specifications – which described good care in the three focus areas: accessible care, proactive care and coordinated care.

Each group met three times and included a diverse range of contributors including NHS England medical directors, GPs, nurses, public health specialists, practice managers, patients, patient representative bodies (such as National Voices), commissioners, contracting specialists and members of various academic and professional bodies.

The role of the expert panels was to define ‘good’ care to address the variation of care provision across London. They brainstormed ideas for solutions to each of their groups’ challenges and eventually came up with a short list of the really crucial offers they wanted to make to patients. These centred on the three aspects of care which mattered most to patients (accessible care, proactive care and coordinated care).

Usually the patients formed about 25% of each panel and they made significant contributions to the meetings, describing their own personal experiences of care and those of friends and family. Their input contributed greatly to the formation of the standards.

The task of the panels was to provide a draft set of standards, in preparation for developing a more detailed set of standards through patient engagement in Stage Three.

The recommendations made by the three panels were initially known as ‘standards’ but due to the connotation of the word ‘standard’, were later re-named ‘specifications’.

Stage Three

 The draft standards were finalised in March 2014. Starting in April 2014, NHS England led a comprehensive year-long engagement phase to test the standards through patient focus groups, charity groups and a clinical challenge panel of multidisciplinary clinicians. The development of the specifications was also overseen by a Clinical Board, Patient Board and Transformation Board.

The patient focus groups consisted of 20 separate cohorts, representing different groups of people – for example mothers with children, commuters, carers, Gypsy Travellers and homeless people. Each focus group discussed their particular needs in terms of accessible care, proactive care and coordinated care through structured and facilitated sessions lasting two hours.

In addition, the Patient Board had 25 members and met every two months from June 2014 to review and input into the Strategic Commissioning Framework , which they approved and was published in March 2015.

Travel expenses were paid to enable and encourage people from all sectors of society to attend meetings as required. To further engage with people, NHS England went outside London, including visiting Gypsy Traveller communities. Multiple half day events were organised with charities to gain their views on specific topics.

Who carried out the activity? 

The work was undertaken by a small team led by the Head of Primary Care Transformation.

There were four or five patients on each expert panel sourced by Paula Lloyd Knight who was the Patient Engagement Lead for NHS England (London Region).

What difference has the activity made?

The final version of the specifications is detailed in the Strategic Commissioning Framework, published in March 2015.  Clinical Commissioning Groups (CCGs) are developing five year plans to implement the specifications as outlined in the Framework.  New models of care are starting to emerge across London with groups of practices coming together to form federations, or “at scale” organisations which provide a wider range of out of hospital services through enhanced contracts.

What, if anything, would you have done differently?

We conducted the patient engagement at a London level and understood that Clinical Commissioning Groups would conduct similar exercises with their local areas. In retrospect we could have linked up the process more clearly, so that people in different areas were asked exactly the same questions, allowing us to test where local variation was important.

Who is the contact for more information?

Christina Windle
Healthy London Partnership – Transforming London’s health and care together
4th floor, Southside, 105 Victoria Street, London SW1E 6QT
Christina.windle@nhs.net

How were people told about the difference their participation had made?

Each participant who was involved in the engagement sessions got a write up of the session and the specification which came out of their support.