Involving patients in family medicine – towards a WONCA policy position

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Policy Bite with Amanda Howe

At the end of October, Dr Luisa Pettigrew represented WONCA at a meeting at W.H.O. in Geneva which aims to help develop thinking around modern good practice in patient and public involvement (PPI)) in health care. The workshop considered issues such as:
• “Meaningful and effective engagement – What does it look like? And how do we measure it?”
• “The roles, responsibilities and expectations of public involvement for patients, family, health-care providers and policy-makers”
• “Creating supportive environment for meaningful and effective engagement – What can we do to make the engagement easier and better?”
• “Initiating and sustaining engagement – different ways for different contexts”.

Colleagues may want to have a working definition of PPI – one popular one says:
“PPI is the process of engaging with the needs and expectations of patients and putting the public and members at the heart of decision making, to ensure that the services and care provided are outcome driven and patient centred. Specifically it is concerned with exchanging information, mutual listening, and accepting that people should be allowed to influence their own care and the services they receive. This can work during an individual’s clinical care; by consulting on and evaluating current services: and by involving the public in new plans and developments for their community.ⁱ”

Family doctors are natural advocates for patient involvement – since we are close to our patients and their communities, and we can see the need to empower people to help themselves where possible, the idea that extra effort may be needed to ensure patients have a voice in their own care may seem strange to us. However, research on this issue has found that organizations which give good care to individuals do not necessarily ask patients as a group for their views and feedback on services. While we often know that an individual patient seems satisfied with their care, it is only when we seek systematic input from patients who are confident enough to tell us if there are problems that we start to get a full picture of what we could do betterⁱⁱ. Feedback on our services is now a routine part of family medicine in many countries, including the U.K; although taking feedback does not routinely result in change - that needs health care providers to want to respond and care about patients’ views, and to have the resources to make the changes needed.

There is also evidence that PPI can improve research and educationⁱⁱⁱ – recent work found that key factors include academic staff having an inclusive approach; getting funding for patients’ travel and time to come to meetings; providing named links and training to help members of the public understand what their contribution can be; and being committed to support them playing such roles^iv.

Finally there are complex issues around different types of PPI – engaging with homeless and vulnerable populations may need quite different approaches to enabling a member of the public to contribute effectively to an ethics committee or a governance board. And models of community engagement and development are usually at a different level from personal facilitation or engagement – a population’s voice rather than those of individuals with a focus on factors that can improve the health and wellbeing of local people.

The debate in WONCA about patient and public involvement has not been a very loud one so far – hopefully this policy bite and feedback from the W.H.O. meeting will begin more discussions about how committed we are as FM practitioners to this agenda in its different forms. Amanda Howe and Luisa have also recently met with representatives from IAPO (‘International alliance of Patients’ Organizations’, see www.iapo.org.uk) to begin to map areas of potential common ground. Looking forward to it!

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References
i www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/278/278we94.htm
ii Howe, A. Can the patient be on our team? An operational approach to patient involvement in interprofessional approaches to safe care. Journal of Interprofessional Care. 2006; 20(5): 527-534.
iii Howe, A. Patient-centred medicine through student-centred teaching – a student perspective on the key impacts of community-based learning in undergraduate medical education. Medical Education 2001; 35:666-672.
iv Mathie E, Wilson P, Poland F, McNeilly E, Howe A, Staniszewska S et al. Consumer involvement in health research: a UK scoping and survey. International Journal of Consumer Studies 2014;38(10: 35–44.