Why is it so hard?
I’ll give a little bit
I’ll give a little bit of my life for you
So give a little bit
Give a little bit of your time to me
(With thanks to Supertramp.)
Patient Participation Groups (PPGs) have been around for decades. They were pioneered in the 1970’s but it wasn’t until 2013 that the Department of Health put some money into the contract that practices have with the NHS to support this. This ‘seed money’ lasted for two years and since 2016 it has been a required element of the GP contract that practices have a PPG.
So why is it still so hard to get a PPG that does something more meaningful that rearranging the posters in the waiting room?
The following observations are my own personal views. I have been on both sides of the fence – working in general practice, working as an NHS manager and more recently trying to be the Chair of a PPG for the practice where I am a patient.
So why is it so hard for PPGs?
The business model:
General practice is the bedrock of the NHS. 90% of interactions between patients and health professionals occur here. Yet practice staff (GPs and everyone else) are not directly employed by the NHS. The Practice has a contract with the NHS and GPs are considered as self-employed by the Inland Revenue. This provides the practice partnership with an annual sum of money and how they distribute amongst themselves and their staff is their decision.
So naturally, this makes them cautious about taking on the latest schemes that the government thinks are a good idea. For example, if they are encouraged to employ lots more nurses, physiotherapists, and other staff to reduce their personal workload, the first question would be – who is going to pay for it? If there is no extra money it means that the doctors (and existing staff) will have to take a pay cut.
The relationship:
One of the greatest benefits of general practice is the on-going relationship that a patient has with their ‘own’ GP. Not having to start from scratch every time you see someone is good for the patient, and good for the doctor. However, when participating in a PPG, both the patient and the doctor have to step away from that role.
The anxiety that PPGs have the potential to become a forum for moaning and complaints about individual personal issues can be a deterrent to many practices.
The workload:
General practice is busy and getting busier. There aren’t enough doctors wanting to become GPs, and for their own sanity more and more are choosing to work part-time. This combined with an ageing population with more complex needs has given rise to longer working hours for doctors and longer waiting times for patients.
The Patient Participation Volunteers:
The NHS guidance around PPGs says that they should be representative of the community. This is a wonderful aspiration but is never going to happen. If you are healthy and rarely need to see the GP why would you join a group? If you are working long hours, and/or caring for others (young and old) why would you want to give up your precious time to join a group? If you think your practice is great and sorts out your problems, why would you want to join a group?
So, who does volunteer for PPGs? My experience is that (myself included) we are older, retired, ex-public sector people who want to make a contribution now that they are no longer working. We are generally not ethnically diverse either. We value the NHS and want to support our practices. But what we don’t want to do is spend hours of our time discussing the poster displays in the waiting area, however overwhelming and obsolete they may be.
What would make it better?
It may seem that everything above is just a bunch of excuses. Maybe it is, but hopefully it illustrates some of the reasons for practice’s lack of enthusiastic for PPGs. So, what actions would make patient participation a worthwhile experience?
Participation
PPGs, as their name implies, need participation – from both the practice and the patients. . Being constantly told that the doctors, nurses, receptionists are too busy to participate is not encouraging. So, as the song says, give a little bit of your time for me.
Tackle real issues
Patients can’t do it by themselves. We, quite rightly, do not have access to practice data, we don’t know what areas are causing concern: clinical, managerial or otherwise. Don’t be afraid to allow the PPG to help and don’t fob them off with trivial projects. If someone from the practice (doctor, nurse, manager) stepped off the treadmill and thought about these issues they could have a dialogue with their PPG, and perhaps work together to the benefit of everyone. It might also provide some additional job satisfaction.
Some (real) examples:
- Diabetes management –practice nurses who run a PPG for patients with diabetes
- Recruitment – patients on interview panels for new staff – including doctors
- Health promotion – open mornings with displays and presentations
- Coffee mornings to reduce loneliness
- Dementia awareness – assessment of the building and training for staff
- Help patients to sign up and use the electronic access to prescriptions
- Information on how services work during the coronavirus pandemic
- Publicity for the influenza vaccine campaign
Don’t be a dragon at the gate
While it is useful to have one person at the practice who is the main contact for the PPG, they should not become a barrier to wider participation. If no-one else knows about the PPG – especially receptionists, membership will never grow.
Do it like you mean it
Practices have to have a PPG. But paying lip-service is just a waste of time for everyone. The most successful groups are those where someone at the practice is enthusiastic – be they a doctor, nurse, manager or paramedic. Having the same, boring, quarterly meeting year after year doesn’t count.
