The majority of primary care trusts are not ready to meet the government’s challenge of fully integrating public and patient involvement (PPI) into the commissioning of services, research by the Picker Institute as found.

An online survey conducted last month, to which a third of all PCTs responded, revealed that although PPI is already a well-established part of operations, few trusts have finalised plans for the new systems they are expected to implement as part of the initiative, and few have integrated PPI into commissioning at high management/budgetary levels or used it in parts of commissioning other than service redesign, the Picker Institute says.

It is widely acknowledged that the NHS is on the verge of a new era in terms of commissioning. Practice-based commissioning, whereby practices have a budget to order their own services to help bring higher quality care to local communities, is one aspect of this, but it is the trusts themselves holding the key purse strings and making the key decisions.

Last year’s white paper Our Health, Our Care, Our Say placed a much greater emphasis on PPI in commissioning services. “Organisations commissioning NHS-funded care must ensure local people play a full part in the planning, design and delivery of their services,” it said, adding: “How well they succeed will form part of their overall annual performance rating.”

New systems for ensuring PPI

In line with this, three new initiatives are currently in the pipeline to help ensure greater interaction with patients and the public: LINks (Local Involvement Networks), which will replace the existing Patient Forums to offer a liaison point between PCTs and the public; patient-initiated petitions, with clear and transparent mechanisms to be set in place for their consideration; and an annual patient prospectus, designed to provide local information and proposals for future investment and commissioning priorities.

But, according to the survey, just six trusts had brought their plans for handling patient-led petitions to their boards, only nine had showcased plans for their relationship with the LINk, and 50% had failed to commission the production of a patient prospectus.

Moreover, the Institute’s research revealed that a most PCTs have low expectations of the results that PPI can bring: 90% of respondents have regular, frequent meetings with their Patient Forum, but a mere 20% think these will have any major influence on decision-making.

The PCTs cited getting to ‘seldom heard’ groups, reliable data on patient experiences and the public’s lack of knowledge of what commissioning means as the biggest obstacles to successful PPI, but a lack of support from senior executives was also reported. A need for training and sharing good practice were identified to help drive progress.

In conclusion, the Picker Institute says that there is a “huge gap to close” before the government’s plea that local people’s voices ‘have to count’ comes to fruition, and that most PCTs are not ready for the new PPI challenges on the horizon.