Engagement enables us to have a two-way conversation with people, so we are actively involving them in improving services. By engaging with our communities, local people and stakeholders, we can understand what works well and what needs improvement.
“Listening to our patients and working in partnership with our communities is central to what we do in general practice and in primary care. Meaningful local engagement is key to getting it right when we make decisions about care and plans for the future. This guide provides us with effective ways of engaging and we will be more effective if we use it.”
Dr Ash Peshen, Deputy Chief Medical Officer, NHS Kent and Medway.
Engagement is about listening, learning and improving services with patients and communities.
It is not:
Training is available for those who would like to develop their knowledge of working with people and communities.
Improves clinical care and the overall experience patients receive - gathering and using local people's experiences can help deliver quality services, which serve our local population, meet their needs and continue to improve quality.
Improves relationships and reputation - a better understanding among our communities and stakeholders and demonstrating a willingness to listen and respond helps to establish good working relationships and a positive reputation.
Contributes to reducing health inequalities - involving and engaging people in decisions about their own health can improve long-term care and better direct resources.
Spots problems and issues early on - by engaging local communities at an early stage, we can identify potential or actual conflict and work towards resolution.
Makes sure we are compliant with our legal duties and with government policy.
The key question to ask is: “Who is affected by this and what do they need the opportunity to influence?”
Training is available for those who would like to develop their knowledge of working with people and communities.
The following principles are taken from NHS England Working in partnership with people and communities: Statutory guidance. It sets out how all health and care organisations should approach engagement.
In Kent and Medway, we have used them as the basis for our strategies and guidance. See the NHS England The 10 principles for working with people and communities.
Patient participation groups (PPGs) is a group of patients at their surgery who work with the surgery to improve things for patients, staff and doctors alike. Since April 2015, each practice is required to have a PPG and to make sure this is representative of the practice population. A PPG will work with the surgery to provide the patient perspective on the services that the practice provides, to become their 'critical friend'.
As the PPG represents the needs of the practice, they are usually made of volunteer patients and members of the practice itself. The PPG should also be open to carers of registered patients, whether they are registered or not themselves.
Having a PPG can contribute to the continuous improvement of services within the surgery and help to establish improved communications between the practice and its patients.
Regular updates from both parties can help patients to take more responsibility for their health, as well as being there to provide practical support and help to suggest and implement changes.
PPGs can also assist the practice in organising services such as flu clinics.
There is no defined way for a PPG to work but many will meet on a regular basis to discuss:
Meetings will usually involve the practice manager and one or more healthcare professionals employed at the practice.
The duration, frequency and content of meetings can be open for discussion when establishing the PPG.
It is a good idea to find out how much support there would be for a PPG within the practice, if you are starting one from scratch, before any attempt at recruitment is made. This could be done by holding an open meeting to pitch the idea, or by advertising the possibility through flyers or electronic messaging screens if they are available. Feedback on the idea could be gauged though members of staff informing patients of the possibility and if they would be interested.
An open meeting could also be used as a chance to recruit. any patient may attend. You will need to advertise widely, giving plenty of notice to attend, which can be by:
You may choose to target certain individuals who are known to the practice and its staff, who would likely be interested in joining. These may be individuals active in the community already, such as parish/town councillors.
It is always advisable that anyone interested in coming to a meeting be encouraged to inform the practice, so you are aware how many people may turn up, so that time and resources are not wasted. If too many are present, you may not have enough time to cover the meeting agenda, or enough refreshments for those attending.
A common issue with PPGs is that they fail to be representative of the practice population, and as a volunteer role, tend to attract people with more free time and flexibility. To make sure the PPG includes a mix of backgrounds, it may be useful to target certain groups of people not represented on the group, so that you get the views of people from minority communities, people with disabilities, etc.
Many of those interested may use the first meeting to decide whether this is something they would really want to be involved in. It's important this meeting be positive and productive, with a good idea of what everyone wants from the PPG going forward. Keeping it brief, perhaps an hour or so, should be enough time to discuss this.
It's important that the expectations and purpose of the group are established - a PPG is not a forum for complaints about the practice, but a platform for co-operation. Meetings going forward should have an agreed date, roughly every 6-8 weeks to ensure enthusiasm for the group does not disappear.
Once meetings are established, it is important to decide the administrative duties of the group:
Establishing a PPG may take time but will grow as the PPG becomes more better known. Many see difficulties such as poor communication, hostility between PPG and practice and volunteer fatigue so it is important to keep in contact with members and the practice and ensure the balance of roles for the PPG.
Useful links for PPGs:
Engaging with people and communities is a key principle that underpins the NHS. All NHS organisations have a legal duty to involve people under the Health and Social Care Act 2012. The main duties on NHS bodies to make arrangements to involve the public are all set out in the National Health Services Act 2006, as amended by the Health and Care Act 2022: section 13Q for NHS England, section 14Z45 for integrated care boards and section 242(1B) for NHS trusts and NHS foundation trusts.
NHS organisations, including those who are contracted by the NHS, must demonstrate how people, carers, local communities and staff are involved in service development and any possible changes that may affect them. All organisations across an integrate care system have a legal duty to involve people in:
Read the guidance on applying statutory duties for integrated care systems.
The NHS Constitution sets out specific rights for all patients including:
NHS Kent and Medway must make sure the duty to involve patients and public has been complied with before agreeing to any changes in local services.
The Equality Act 2010 was brought in to protect people against discrimination in the workplace, in education, as a consumer and when using public services.
The act identifies nine protected characteristic groups, which are explained in more detail in the section on page 11 titled Equality and diversity - reaching different communities.
In 2022 the national Fuller Stocktake review looked at the delivery of local services and made recommendations around developing integrated local teams to deliver care in a more joined up way.
Involving communities and working in partnership with people is key to delivering effective integrated care. The findings stress partnership work 'focuses on genuine co-production and personalisation of care, bringing local people into the workforce so that it reflects the diversity of local communities, and proactively reaching out to marginalised groups breaking down barriers to accessing healthcare.'
PCNs have the benefit of working at a neighbourhood level with local communities, to understand local needs and reduce health inequalities.
PCNs are also a key partner in place-based partnerships, also known as health and care partnerships (HCPs). There is a need to work with people and communities to strengthen health promotion and treatment at this partnership level.
It is essential we involve people in changes that may affect services, including branch closures, changing location and opening times of services.
All GPs must establish and maintain a patient participation group (PPG) to gain the views of patients and to help gather feedback from patients about services. PPG membership should be regularly reviewed to make sure the group is representative of registered patients.
All practices must evidence they have engaged with their PPG throughout the year and work with the PPG to engage with patients and to feed back to the patient population (GMS Regulations Part 5, Regulation 26, PMS Regulations Part 5, Regulation 20).
When engaging local communities and patients, it is important to:
There are many methods to engage people. It is important to provide a range of opportunities for local people to have their say or get involved. Your patient participation group(s) will be able to help you identify ways of carrying out engagement.
When considering each of these approaches, it is important to think about:
Examples of ways to engage with people and our communities:
For further information on methods and approaches to engage with people and communities, read the Engagement Methods.
Since 2020, engaging and meeting with people online has become popular. There are many benefits to this, including saving time and travel. However, due to increased use of digital technology, digital exclusion has been highlighted and not everyone has access or the knowledge to use the tools.
We recommend you offer both online meetings and another engagement approach, for example a focus group or a coffee morning.
There are many online meeting platforms, the most popular ones being Zoom, Skype, Microsoft Teams and Google Meet. Each has benefits and abilities to engage with your audience; there is no right platform to use, it comes down to your preference.
Tips to bear in mind when running an online meeting:
Always remember virtual meetings are still meetings and need the same organisation as if face-to-face.
Further tips on using an online platform can be found here.
There are social media platforms you can use to promote your services and engage your patients and communities, which include Facebook, NextDoor, Instagram, TikTok and more. Before you make a decision about which to use, think about the audience you want to target, what you want to share or tell them and the social media platform you need to use to reach them.
You should also think about the resource needed to run these platforms and how they will be managed. 93 per cent of online adults use Facebook. Like all engagement, it will take time to build up a following and for people to engage with your posts, so don't be disheartened; try sharing different topics and you will start to see people re-post, share and engage more. But don't expect everyone to come to your page, they won't.
Conversations about your practice are already happening in Facebook community groups or on next door, be aware of them, listen to what is being said - you don't always have to respond directly but it can help flag issues that need further exploration.
You can find advice and help on social media on the GP communications and engagement toolkit and resources page
Building supportive and trusting relationships with your local communities and key stakeholders and understanding the way they want to engage is critical. Understanding the needs and views of people, communities and stakeholders will help you understand and consider the impact of plans and decisions.
You might want to engage/involve:
A full stakeholder mapping tool can be found in the PCN/ General practice stakeholder list and stakeholder mapping tool.
As mentioned in section three, all NHS organisations must comply with the Equality Act 2010. It would benefit you to carry out an equality impact assessment and a health impact assessment, to identify people in your community who have a protected characteristic or are a community or group, that is socially underserved. There are nine protected characteristic groups; they are:
Engagement approaches with people from these groups need to be fair and equitable. This means recognising that not every type of involvement works for everyone; there can be additional needs with some groups, so you may have to carry out a range of activities. NHS England suggests:
Alongside the protected characteristic groups, NHS England says there are inclusion health groups, which are communities that experience the poorest health inequalities, for example poverty, social exclusion, discrimination and many more.
These groups include:
To support and meet the needs of protected characteristic groups and inclusion health groups, you will benefit from working in partnership with the voluntary and community organisations in your neighbourhoods or local area.
Voluntary and community organisations:
If you are making a material or substantial change to premises or to services, you will need to engage and involve your patients, staff and key stakeholders from an early stage to the end of the process.
Material or substantial change includes the permanent closure of a branch surgery, merger with another practice or proposals to relocate to new premises. Engagement takes time and some resources - but it will save you time and money in the long run. Getting it wrong can lead to opposition to your plans, which can impact on your relationship with the community you serve, or even lead to a legal challenge by judicial review, which is costly and time consuming.
For tips and guidance on involving people and staff in material or substantial change, see: GP guide to premises changes.
Before starting any engagement, make sure you have considered the following: