Supporting you to safely and effectively meet the needs of your patients
Londonwide LMCs are increasingly aware of the pressure on GPs and practice colleagues caused by unrealistic contractual and public expectations. GPs are being pushed to carry out more and more clinical encounters with fewer GPs.
We know that this decreases the safety and quality of individual patient encounters, and also reduces the effectiveness of our services through compromise of the core values of general practice– such as continuity of care, holistic person-centred care with a family and community focus. Unsurprisingly, there is an adverse impact on the experience of both patient and clinician.
As effectiveness and quality drop, and people will understandably value our services less and our relationships with our patients and our local communities become fractured.
However despite these challenges, in most cases, our patients remain our greatest allies and have a role in helping us to navigate this quantity versus safe care and quality predicament.
Some of our patient groups may be particularly under-served and disadvantaged in this environment of incredible pressure on practices to increase the number of encounters and consequently reduce the time spent with each patient, irrespective of complexity of need. This is likely to apply to those who have the highest health needs and experience health inequalities.
The GP Committee of the BMA advises practices to protect patients and clinical staff from these risks by limiting clinical contacts to no more than 25 per day for each GP, and any excess demand beyond this being signposted to other settings such as NHS 111, overflow hubs, or urgent treatment centres. This is permitted within the new imposed contract which says that patients should be offered assessment of need or be signposted to an appropriate service.
The GMS contract provides practices with autonomy in how we deliver services. In summary:
- The GMS regulations allow individual practices to decide which services to provide when, to meet the needs of their patients.
- Practices should be able to show they have engaged with their patient participation group (PPG) to check the arrangements are meeting their reasonable needs, and are addressing any areas of concern (within the regulations regarding PPGs).
What is the PPG requirement?
NHS England and Care Quality Commission (CQC) have both clarified that the PPG requirement in the contract does not need to be fulfilled through a traditional model PPG. CQC state:
“The National Health Service (Personal Medical Services Agreements) Regulations 2015 state that providers must establish and maintain a group to obtain the views of patients about the services they deliver and enable them to obtain feedback.
“The regulations refer to this as a patient participation group (PPG). In practice, this does not need to be a formal PPG with specific named members, a chair and a secretary that records minutes of meetings. It can also be a ‘group’ made up of the full patient list. Practices can gather feedback in any way they feel is right for their patient population. They may find they can have more effective conversations through engaging with different community groups at different times and in different places. Practices may also choose to use digital technologies to engage with patients to reach more people, such as SMS messaging, social media and other online methods.”
How can we support you?
Londonwide LMCs would like to support you to work with your patients to navigate this quantity: quality predicament and work to ensuring safe patient care. In addition, we want to help you to raise the voices of patients and the public; raise awareness among your local communities about the true pressures facing GPs and practices; and increase empathy between colleagues and patients in support of finding mutually agreeable solutions.
An overview of the patient participation programme
We commissioned Co-Create who are experts in this field and have been working with practices for the last five years to develop knowledge, skills and methods for supporting productive conversations with people and communities.
Via this collaboration, we have produced the following resources to help you to engage with your patients:
- Resource to help you consider whether undertaking a patient participation exercise is right for you
- Guidance for setting up a safe care workshop
- Co-create guide to session invitations
- Safe care workshop plan and facilitators notes
- Safe care workshop workbook
- Guidance following the safe care workshop
- Co-create advice on keeping people in the loop
If you require any further advice or support, please contact us at info@lmc.org.uk.