Five principles to help commissioning consortia get public and patient involvement right

To secure the required level of savings, healthcare will need to be delivered differently. The central challenge for GP commissioners will be to develop new pathways which bring higher quality and lower cost. 

Inevitably, consortia will need to bring about major service change. Experience suggests this will often mean more services outside of hospital settings, with acute care provided on fewer, more specialised sites. Examples include the hyper-acute stroke unit model and service reconfiguration proposals for A&E and maternity services in many parts of the country.

Why does communication with patients, partners and local stakeholders matter? Making service change happen will continue to be difficult, and challenge remains a bruising process if you win – and hugely expensive and time-consuming if you lose.

For GP commissioners getting it right will be critical for two reasons:

• They must deliver service change on a significant scale;
• Getting it wrong jeopardises relationships with politicians, the local media and their patients.

So how to get it right?

These five principles are based on conversations with individuals “battle hardened” in shaping service and organisational change within GP practices, trusts, PCTs and the regional NHS, together with Verve Communications experience working with NHS organisations through change - including the largest and most complex service reconfiguration in London to date.

Written with GP commissioners in mind, they are equally relevant to anyone planning service changes in healthcare.

1) Reputation and relationships matter – both rest on open, honest communication with local people and stakeholders

Go out of your way to show that you are listening, and always report back on key points, particularly concerns. Focus on being as inclusive as possible, for example arranging public meetings so everyone can contribute. Increasing participation avoids the agenda being dominated by small groups, individuals or views.  

Media scrutiny may be intense, so prepare the Q&A thoroughly – particularly your response to challenging questions. Rehearse spokespeople and establish protocols to ensure that responses are coordinated, and everyone knows who has said what. 

2) Develop channels to support direct communication, rather than allow dialogue to be mediated by others

Identify the trusted networks which really drive opinion within communities, and take time to offer individual, face-to-face briefings and explanations of the case for change.  Proposals may involve trade-offs, so make sure that each group has fully understood all the benefits relevant to them.

Understand the politics. Consider the positions and possible motivations of stakeholders.  Politicians instinctively understand the difference between public comment and “behind-the-scenes” negotiation – this can be confusing for an outsider. Talk with advisers and committee officers, as they can help you head off problems.

3) Timing is important – so keep control of it!

Lead times can be long, so sort out the political diary early (e.g. meetings of Health and Wellbeing Board, Cabinet etc.), and don’t forget NHS partners (e.g. ambulance service, adult social care, and neighbouring trusts).

Share plans in good time, and regularly update staff and stakeholders on progress. A key responsibility of the programme board is to keep up momentum, ensuring that plans are produced on time. Be ready to make timely responses to local debates on issues important to the local community, and to kick-off debates if needed.

4) Stay on top of the case for change

Be your own harshest critic on the evidence you put forward to support change, because it must stand up to scrutiny. In particular, think through:

• Representativeness of statistical information
• The internal credibility of data with senior clinicians
• Whether to use specialist agencies to provide independent review or evidence gathering, including consultation activities
• How you can involve and enlist the support of partners and professional groups for your evidence.

Keep it simple and use the evidence – if you cannot explain your key points in lay terms, your argument is probably weak!

5) Plan for challenge from the outset

Freedom of Information and the Independent Reconfiguration Panel review process, mean it is essential to have a comprehensive document management system to organise key papers and notes of decisions (including attendance). All statements issued should be justified with reference to documentary evidence.

Your decision-making process must stand up. Governance structures should make sense, and the logical steps through which evidence is considered and advice taken must be navigated and recorded explicitly.

GP commissioners will need to develop new approaches to this. Based on the experience of GP decision-making so far to support the secretary of state’s “four tests” for reconfiguration proposals, the key questions are:

• How to reach a consensus (or workable majority) view in a GP-led process?
• How to secure buy-in from GPs not directly involved, especially those who still have reservations?
• How to enable everyone to participate while ensuring the process is manageable?
• Who should be spokesperson for the decision, and what support will they need?