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Crunch time for patient involvement

 

Blog headlines

  • What now for commissioning?
    3 December 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What White people don’t see
    26 November 2020

    This year’s Black History Month (BHM) has, unfortunately, in its shadow another example of why campaigns like this exist.

  • Primary Care: Why don’t we talk about Racism?
    20 November 2020

    Rita Symons is an ex NHS leader who is now a leadership consultant, coach and facilitator. Her work is mainly in the NHS and she is an associate for PCC offering facilitation, coaching, strategy development and team development activities. She is a concerned but hopeful world citizen and combines work in the NHS with a board role in a non for profit organisation and an interest in writing.

  • Primary Care and the Health of the Public
    12 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What now for primary care
    4 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • Boosting your resilience
    30 October 2020

    The last year has been a difficult one, who would have imagined last Christmas that we would have been in lockdown, with the NHS seriously tested by a global pandemic. So much change has happened and the resilience of people working in and with health and care services has been seriously tested. Resilience is our ability to deal with, find strengths in and/or recover from difficult situations. Its sometimes referred to as “bounceabiliy” – but bouncing in what way?

  • Link of the week: National Cholesterol Month
    23 October 2020

    Every month or week of the year seems to be an awareness week, October has more than its fair share.

  • New redeployment service offers talent pool of motivated, work-ready individuals
    15 October 2020

    People 1st International have shared some of the work they are doing to support people displaced from industries due to the Covid-19 pandemic. There is an opportunity for health and care services to benefit from this workforce.

  • Link of the week
    9 October 2020

    Article published in the BMJ looking at the ability of the health service to quickly bounce back to pre-Covid levels of activity and considers if it is desirable.

  • Virtual Consultations– the patient perspective
    2 October 2020

    This week Jessie Cunnett, director of health and social care at Transverse has shared this article.

  • Virtual Consultations– the patient perspective
    1 October 2020

    This week Jessie Cunnett, director of health and social care at Transverse has shared this article - Virtual Consultations– the patient perspective.

  • Celebrating innovation in eye research
    24 September 2020

    This week Julian Jackson from VisionBridge has shared a report on eye research.

  • Link of the week: Comprehensive Spending Review and Covid-19
    24 September 2020

    This week we are sharing a blog that outlines the funding pressures and uncertainties faced by the health and care system

  • Risk stratifying elective care patients
    10 September 2020

    This blog has been shared by MBI healthcare technologies. As services are starting to treat routine patients those on waiting lists are making enquiries as to where they are on the list, and if they are still on the list.

  • Link of the week
    4 September 2020

    This week the link we would like to share are reflections from physiotherapy students on placement at Alzheimer Scotland https://letstalkaboutdementia.wordpress.com/

  • Link of the week
    28 August 2020

    This week we would like to share a blog published on the Mind website about being a BAME health worker in the pandemic.

  • Remote clinical triage model
    20 August 2020

    This week we are sharing how a remote clinical triage model was implemented at Tollgate Medical Centre. This has been shared with us by Sarah Portway, a Nurse, and Clinical Services Manager at Tollgate Medical Centre.

  • Can the Community Pharmacy become the gateway to integrated care in the NHS?
    13 August 2020

    The NHS is a continually evolving innovative demand led public service the role of the Community Pharmacist is becoming the public face on a journey to the more responsible public engagement in the personal care of individuals and their family. There are currently over 11000 Pharmacies many are single or small chain service providers, while multiples occupy the urban shopping centres and more densely populated conurbations, the value of the rural High Street can’t be understated.

  • Crunch time for patient involvement
    7 August 2020

    There are new challenges for primary care, which could really do with patient input. Mike Etkind, chair of a PPG and founding member of his PCN’s patient group, recognises the size of the task clinical directors have managed over the last few months but identifies two particular issues where patients have a necessary and valuable contribution, that need to be addressed now – the 2020 vaccination programme and primary care from a distance- total triage, remote consultations, and the use of telemedicine.

  • Link of the week - Visionbridge
    31 July 2020

    The link we are sharing this week was submitted by Julian Jackson, Visionbridge.

 
 
Friday, 7 August 2020

Crunch time for patient involvement

There are new challenges for primary care, which could really do with patient input. Mike Etkind, chair of a PPG and founding member of his PCN’s patient group, recognises the size of the task clinical directors have managed over the last few months but identifies two particular issues where patients have a necessary and valuable contribution, that need to be addressed now – the 2020 vaccination programme and primary care from a distance- total triage, remote consultations, and the use of telemedicine.

Eighteen months ago I wrote an article in PCC Insight about whether patients were being involved in setting up and running PCNs. I’ve seen a few tentative steps forward, but nothing that could be described as co-design or co-production. Now there are new challenges for primary care, which could really do with patient input.

The only reference to patient participation in NHS Confederation PCN Network’s One year on report is a quote from a clinical director (CD) that they “are still firefighting and have no opportunity to increase patient participation”.

It would be foolish not to recognise the size of the task CDs have and that engagement with patients hasn’t been the top of the list since the pandemic hit. I don’t say that patient engagement was impossible during lockdown, but I can understand that it got lost among many other priorities.

However, with apparently more and more instructions and directives hitting GP and practice manager desks since lockdown began, perhaps they can now sympathise more with patients who want a say in what and how their primary care services are delivered.

Moreover, Covid has shown how valuable community action can be in a crisis (in some cases at PCN scale) – something that might be built on in PCN’s intended role as being a local focus for bringing together all parties involved in healthcare and social care at local level.

At the time of writing, there are two particular issues where I believe patients have a necessary and valuable contribution.

2020 vaccination programme

My first issue is short-term: how to make this year’s flu vaccination programme work and maximise numbers vaccinated. GPs face not only the constraints of social distancing, but also the addition of 50 to 65 year-olds swelling the ranks of those eligible. Doubtless there are other issues I’m not aware of.

I’ve spotted that at least one PCN has been working up a plan to deliver a single vaccination programme for all its member surgeries. I guess many surgeries are holding fire on their final planning in expectation of central guidance on how to manage the process.

From a patient perspective, what options are likely to make us more likely to go for a jab? Has anyone asked? Will patients feel safer and be more likely to attend an outside venue, perhaps with a drive-through facility? Or will use of the surgery with a one-way system through their existing building attract just as many? How accessible is the proposed venue? Will vulnerable patients be treated differently – bigger gaps between slots or whatever? How will patients reach the venue: easy access by public transport would have been a consideration, but does thinking need to be altered if some patients are now wary of using public transport? Maybe temporary vaccination venues at more than one location in a surgery’s catchment area would be helpful as a way of minimising travel?

The breadth of any patient engagement may have to be limited by time and resources. But at minimum a surgery’s PPG may be able to offer some insights, even if surgeries’ options are ultimately limited by central guidance.

Primary care from a distance

This second issue is medium and long-term. It seems pretty certain that Covid driven developments such as total triage, remote consultations, and use of telemedicine, are to a greater or lesser extent likely to be here to stay.

As far as I can tell, patients have largely embraced the changes since March. Needs must; and for many, these new arrangements may be seen as an improvement over the ‘old normal’ as well as perhaps encouraging greater self-care. But what is the range of views about these arrangements maybe becoming permanent?

We already have an insight report from National Voices and Healthwatch*. This seems a valuable early contribution to patients’ experience and it calls for a ‘blended’ approach to meet the needs of patients.

Patient needs and wishes will vary and I believe even those who are positive about the changes are likely to have questions. These should be invited and welcomed as a help in designing future systems. And, if taken seriously and responded to, may help give all patients some reassurance that things will work for them. Questions like:

  • Will GP face-to-face appointments become such a rarity that patients, particularly those with long-term conditions, will lose the relationship with a particular doctor?
  • How does remote consultation or use of apps work with those with learning disabilities or dementia…?
  • How do you check remotely a possible ear infection in a child or the feet of someone with diabetes or something intimate…?
  • Do we need to be wary of over-medication because GPs feel the need to cover themselves more when not seeing a patient face-to-face?
  • What help – financial or technical – can we expect if we are now going to be invited to get our own blood pressure monitors or to use apps to manage our condition?
  • Will I find different approaches if I ‘see’ different health professionals in my PCN?

Most of what I’ve seen written about the ‘new normal’ in primary care focuses on the technicalities and what is achievable and what works for the healthcare system. In order to bring patients of all sorts along with the changes, we need to be informed, involved and engaged. No-one wants to be talking in the next few years about how the major shift in delivering primary care disadvantaged the less robust in society because patients were not at the heart of things.

The Doctor Will Zoom You Now: getting the most out of the virtual health and care experience.