Details of the way 'community petitions' could be used to trigger formal service reviews have been revealed in a Department of Health paper.
The document, circulated to strategic health authority patient and public involvement leads in September, sets out options for the number of signatories which would require a formal review.
It suggests the trigger could be 1 per cent of the public served by a primary care trust, or 10 per cent of users of the service. Alternatively, it proposes a 'baseline' of 250 signatories in line with proposals on local engagement already set out by the Department for Communities and Local Government.
If reviews found services or providers to be unsatisfactory, PCTs would be obliged to tender for an alternative provider, using local government's 'best value' principles.
Final proposals are due to be published in the NHS operating framework in December.
The paper, which called for 'consultation responses' by 6 October, also discusses the need to discourage 'trivial', repetitive or 'vexatious' petitions and ensuring that marginalised members of the community and children have a voice (see below).
It suggests petitions could be set up and run by local involvement networks (Links), which the DoH has proposed as a replacement for 'overburdened' patient forums.
Links will allow commissioners, local authority health scrutiny committees and regulators to gauge public opinion and act as a 'conduit' for local people to express views.
Each Link would include representatives of local voluntary and community organisations and interested individuals. Commissioners would be able to fund Links to carry out local research on proposed changes, but they would also be able to initiate their own investigations and 'champion local issues' using petitions.
A Department of Health spokesman said the document was part of a wider consultation on the NHS commissioning framework: 'A presentation was given to these [public involvement] SHA leads, and definitive policy on these areas is currently under development following this consultation process. The results of this will be published in the NHS operating framework in December.'
Despite the DoH description of the process as one of 'consultation', PPI leads contacted by HSJ were not prepared to share their views.
But Elizabeth Manero, director of patient involvement organisation Health Link, welcomed the proposals: 'Scrutiny committees are all very well but they are run by political parties. Petitioning climbs past all that and can't be manipulated.'
However, Malcolm Alexander, chief officer of the London Ambulance Service patients' forum, described the idea as 'a joke'.
'Links will have no powers and no statutory duties. They are saying you won't be allowed to monitor anything, but you can send a petition in.'
Surrey PCT said it supported the notion of a system by which local people could call for changes if they were dissatisfied with a service or identified gaps in provision. But a spokeswoman called for clear guidance on how such a scheme would work, adding: 'The use of the term &Quot;petition&Quot; has the potential for this process to be confused with the consultation processes for changes to services and it is essential that there is central clarification from the DoH to avoid this.'
NHS Confederation policy manager Maria Nyberg said that Links could be the ideal vehicle for involving and engaging local people. But she was uncertain about petitions.
'We want to be able to create a framework which would pick things up before it got to the stage where so many people were aware of it that it generated a petition.
'We are not certain that we need the power of petition - it's too much of a last resort and sets out from the premise that there is a problem. Also, how many people would you need to trigger a petition: 1 per cent, 2 per cent, 10 per cent?'