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Patient participation DES rules explained

The requirements practices must meet to secure payment for this directed enhanced service.

The practice must detail steps taken to ensure the patient reference group reflects the registered list (Photograph: Image Source)
The practice must detail steps taken to ensure the patient reference group reflects the registered list (Photograph: Image Source)

The patient participation directed enhanced service (DES) only applies in England and is rewarded at up to £1.10 per patient depending on the level of achievement. It is currently funded for two years - 2011/12 and 2012/13.

Practices are asked to facilitate the formation of a patient reference group (PRG) reflecting their registered list. The group will feed back health concerns to support decision-making for practices and GP consortia.

These views will be supported by patient surveys and the results of these will be reported back to the wider population.

Patient reference group
Establishing a group is the first step and contributes 20 per cent of the reward in the first year. While many practices already have such a group in place, others will be seeking advice on setting one up.

Guidance jointly issued by NHS Employers and the BMA suggests that setting up a virtual PRG - an online email community - is one answer but in most cases I suspect the more traditional route, inviting the patients to attend an inaugural meeting, will be used.

Developing a PRG of registered patients may be achieved by various methods. These include advertising an open meeting using techniques such as notices on repeat prescriptions or asking a well-known local figure to develop a group.

Group formation advice
Advice is available from the National Association of Patient Participation (NAPP). It also gives advice on ensuring these groups run successfully and do not simply become focused on one issue.

One potential difficulty is that, if its PRG does not have wide enough representation of the registered population, the practice may be criticised and have money withheld. PRGs are to be independent and consequently practices would be justly criticised if they tried to influence their PRG's membership.

Practices wishing to participate in this DES need to have or to create a website as a report must be displayed online.

Patients' views
To receive the maximum £1.10 per patient, practices must agree priorities with the PRG and then undertake a yearly survey of their patients to establish local views. The issues discussed will vary but there is an expectation that this will usually include access.

The emphasis is on locally agreed surveys with questions based on priorities identified and agreed by the PRG and practice. There is no standard survey format and no requirement for a minimum number of respondents.

Questions can be taken from validated surveys on the NAPP website or devised locally. The only stipulation is that 'a reasonable person' would be confident that the processes used produce results that are valid. The method of data collection should be decided by local agreement and could include post, waiting room surveys or email.

The practice has responsibility for organising the survey and can either carry it out itself or use a provider organisation.

Survey results
Having collated the results, the practice should discuss these with the PRG. Other relevant information, such as anony-mised complaints or significant events, may be included in this discussion.

Where potentially significant changes in service provision have been identified, the practice should discuss these with the PRG to ensure both parties are in agreement before changes are implemented. It may be necessary to check with the PCT on some changes, especially if they are likely to affect any contractual arrangements.

These discussions and hopefully subsequent agreements on change may take place at one or a series of meetings. Alternatively, this could all be arranged through email.

After this, a report should be published on the practice's website and a copy sent to the PCT. There are certain minimum standards the report must meet, including detailing the steps taken to ensure PRG is representative; how agreement was reached with the PRG on priority issues to survey and an action plan for proposals arising from the survey.

Practices are encouraged to draw patients' attention to the report, for example by posters in the waiting room. It is suggested that the report should be available for CQC inspections and sent to other local bodies, such as HealthWatch, practices and consortia.

While practices with established patient groups and a website should have little problem, others may struggle.

Primary Care Commissioning has published a toolkit on its website to support practices.

The group must be in place to debate the local healthcare issues, agree a survey and then meet to discuss the results and produce a report by 31 March 2012. If the report is not on the practice website by then, no payment will be made.

Much of this DES only formalises what occurs already in many practices. The emphasis on publishing a report does suggest the DoH wants action to be seen to be done.

  • Dr Phipps is a GP in Lincolnshire


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