People and communities toolkit

Engaging with people and communities is a key principle that underpins the NHS. All NHS organisations have a legal duty to involve people under the Health and Social Care Act 2012. The main duties on NHS bodies to make arrangements to involve the public are all set out in the National Health Services Act 2006, as amended by the Health and Care Act 2022: section 13Q for NHS England, section 14Z45 for integrated care boards section and section 242(1B) for NHS trusts and NHS foundation trusts

NHS organisations, including those who are contracted by the NHS, must demonstrate how people, carers, local communities and staff are involved in service development and any possible changes that may affect them. All organisations across an integrate care system have a legal duty to involve people in:

• setting priorities
• any proposed changes that may have an impact on patients
• any decisions that affect the operation of services – including primary care
• involving people in their own care along with their families and carers – CQC Involving and engaging with the patient population and local communities

Guidance on applying statutory duties for integrated care systems can be found here.

The NHS Constitution sets out specific rights for all patients including:

• the right to have an open and transparent relationship with organisations providing care
• the right to be involved in the planning of healthcare services and in proposals to change those services.

NHS Kent and Medway must make sure the duty to involve patients and public has been complied with before agreeing to any changes in local services.

The Equality Act 2010 was brought in to protect people against discrimination in the workplace, in education, as a consumer and when using public services. The act identifies nine protected characteristic groups, which are explained in more detail in the section on page 11 titled Equality and diversity – reaching different communities.

In 2022 the national Fuller Stocktake review looked at the delivery of local services and made recommendations around developing integrated local teams to deliver care in a more joined up way.
Involving communities and working in partnership with people is key to delivering effective integrated care. The findings stress partnership work ’focuses on genuine co-production and personalisation of care, bringing local people into the workforce so that it reflects the diversity of local communities, and proactively reaching out to marginalised groups breaking down barriers to accessing healthcare.’

PCNs have the benefit of working at a neighbourhood level with local communities, to understand local needs and reduce health inequalities.

PCNs are also a key partner in place-based partnerships, also known as health and care partnerships (HCPs). There is a need to work with people and communities to strengthen health promotion and treatment at this partnership level.

It is essential we involve people in changes that may affect services, including branch closures, changing location and opening times of services.

All GPs must establish and maintain a patient participation group (PPG) to gain the views of patients and to help gather feedback from patients about services. PPG membership should be regularly reviewed to make sure the group is representative of registered patients.

All practices must evidence they have engaged with their PPG throughout the year and work with the PPG to engage with patients and to feed back to the patient population (GMS Regulations Part 5, Regulation 26, PMS Regulations Part 5, Regulation 20).

The following principles are taken from NHS England Working in partnership with people and communities: Statutory guidance. It sets out how all health and care organisations should approach engagement.

In Kent and Medway, we have used them as the basis for our strategies and guidance. See the NHS England The 10 principles for working with people and communities.

When engaging local communities and patients, it is important to:

• identify and engage the right people – are there audiences which you will need to reach out to in a different way?
• be clear about what you need to find out from the engagement
• be clear about the terms of engagement – what can people expect to happen? What is included and not included?
• provide sufficient information in plain English and accessible formats
• choose the right format and use channels and mechanisms that work for people
• listen, encourage feedback and act on it
• treat people as equal partners
• build trust and manage expectations
• provide support to overcome barriers to people’s involvement.

There are many methods to engage people. It is important to provide a range of opportunities for local people to have their say or get involved. Your patient participation group(s) will be able to help you identify ways of carrying out engagement.

When considering each of these approaches, it is important to think about:

• recording and analysing: How you will record and analyse the responses – who will do this and which methods will you use?
• feeding back: How will the results be shared/fed back with those who have taken part. A feedback session, focus group or workshop may take place after a survey, for example. All participants at an event or workshop should be thanked.
• timings: Allowing plenty of time to get people involved and carefully consider timing – whether you are asking people for times over key holidays or when it is best to reach people during the day or week.

Examples of ways to engage with people and our communities:

For further information on methods and approaches to engage with people and communities, see Engagement Methods

Since 2020, engaging and meeting with people online has become popular. There are many benefits to this, including saving time and travel. However, due to increased use of digital technology, digital exclusion has been highlighted and not everyone has access or the knowledge to use the tools.

Online meetings

We recommend you offer both online meetings and another engagement approach, for example a focus group or a coffee morning.

There are many online meeting platforms, the most popular ones being Zoom, Skype, Microsoft Teams and Google Meet. Each has benefits and abilities to engage with your audience; there is no right platform to use, it comes down to your preference.

Tips to bear in mind when running an online meeting:

• Come up with clear virtual meeting practices or rules.
• Give everyone time to familiarise themselves with the tools, such as mute button, raise hand button.
• Expect glitches and loss of connection.
• Plan breaks, especially for longer meetings/workshops.

Always remember virtual meetings are still meetings and need the same organisation as if face-to-face.

Further tips on using an online platform can be found here.

Social media

There are social media platforms you can use to promote your services and engage your patients and communities, which include Facebook, NextDoor, Instagram, TikTok and more. Before you make a decision about which to use, think about the audience you want to target, what you want to share or tell them and the social media platform you need to use to reach them. You should also think  about the resource needed to run these platforms and how they will be managed. 93% of online adults use Facebook. Like all engagement, it will take time to build up a following and for people to engage with your posts, so don’t be disheartened; try sharing different topics and you will start to see people re-post, share and engage more. But don’t expect everyone to come to your page, they won’t. Conversations about your practice are already happening in Facebook community groups or on next door, be aware of them, listen to what is being said – you don’t always have to respond directly but it can help flag issues that need further exploration. You can find advice and help on social media on the GP Communications and engagement toolkit and resources page

Building supportive and trusting relationships with your local communities and key stakeholders and understanding the way they want to engage is critical. Understanding the needs and views of people, communities and stakeholders will help you understand and consider the impact of plans and decisions.

You might want to engage/involve:

• patients (service users) families and carers
• patient participation groups
• other local practices
• local pharmacies
• residents – considering all demographics
• volunteers
• members of staff – clinical and non-clinical primary and secondary care
• under-served (and under-represented) communities – for example gypsy/traveller and Roma, people with a  learning disability, people for whom English is a second language, rough sleepers/homeless
• community and faith leaders
• voluntary, community and social enterprise (VCSE) such as Carers’ Support, local Age UK and Mind
• voluntary and community groups, such as faith groups, sports clubs, yoga and meditation groups, support groups, residents’ association, men’s sheds, craft groups, mums’ groups
• local councils – including county, unitary, district/borough and parish councils (and councillors)
• other services – including social care providers, health centres, schools, job centres, emergency services, leisure centres, family resource centres and local bus services.

A full stakeholder mapping tool can be found in the PCN/ General practice stakeholder list and stakeholder mapping tool.

As mentioned in section three, all NHS organisations must comply with the Equality Act 2010. It would benefit you to carry out an equality impact assessment and a health impact assessment, to identify people in your community who have a protected characteristic or are a community or group,  that is socially underserved. There are nine protected characteristic groups; they are:

• age
• gender
• race
• disability
• religion or belief
• sexual orientation
• gender reassignment
• marriage or civil partnerships
• pregnancy and maternity.

Engagement approaches with people from these groups need to be fair and equitable. This means recognising that not every type of involvement works for everyone; there can be additional needs with some groups, so you may have to carry out a range of activities. NHS England suggests:

• using accessible venues, making reasonable adjustments or specific effort to make sure disabled people, autistic people and people with a learning disability can participate
• working with peer support workers to facilitate the involvement of people who may be struggling with their mental health
• targeting resources and approaches at ethnic minority groups to provide additional support that some of their members will need because of the health disparities they experience
• recognising that deprivation and poverty can prevent people taking part in activities unless financial support and resources are in place, toenable their involvement
• considering health literacy levels and language. Content should be relatable rather than using NHS terms and acronyms. Jargon can be a barrier for everyone
• accounting for digital literacy and access to digital systems in areas of socio-economic deprivation
• building people’s knowledge of how different parts of the health and care system fit together and where their input will make a difference. People will be at different levels of understanding about the NHS structures.

 Alongside the protected characteristic groups, NHSE England says there are inclusion health groups, which are communities that experience the poorest health inequalities, for example poverty, social exclusion, discrimination and many more.

These groups include:

• gypsies, Roma, travellers, showmen and liveaboard boaters
• people experiencing homelessness
• people experiencing alcohol and/or drug dependence
• sex workers
• vulnerable migrants and refugees
• young carers
• victims of modern slavery
• people in contact with the criminal justice system.

To support and meet the needs of protected characteristic groups and inclusion health groups, you will benefit from working in partnership with the voluntary and community organisations in your neighbourhoods or local area.

Voluntary and community organisations:

• are often trusted, accessible and skilled at outreach and engagement
• have routes into and established relationships with different groups, especially those that experience health inequalities and can help communicate with them
• provide expertise in directly working with people and communities in service planning and delivery, including experience of community-centred approaches
• have knowledge of the needs and strengths of those they work with and can support them to be more directly involved in health and care strategies and plans.

If you are making a material or substantial change to premises or to services, you will need to engage and involve your patients, staff and key stakeholders from an early stage to the end of the process.

Material or substantial change includes the permanent closure of a branch surgery, merger with another practice or proposals to relocate to new premises. Engagement takes time and some resources – but it will save you time and money in the long run. Getting it wrong can lead to opposition to your plans, which can impact on your relationship with the community you serve, or even lead to a legal challenge by judicial review, which is costly and time consuming.

For tips and guidance on involving people and staff in material or substantial change, see: GP Guide to Premises Changes

Before starting any engagement, make sure you have considered the following:

1. Aims and objectives – why you are engaging, what you need to know and what participants are able to influence?
2. Who to engage with – who you need to engage with and any specific needs your participants may have? Complete a stakeholder mapping exercise and impact assessments.
3. Level and method of engagement – what are the most appropriate methods of engagement?
4. Planning – project plan your engagement activities and develop your project timetable
5. Budget – what will your engagement cost and how will you resource it, including staffing?
6. Gather data and knowledge – check what information already exists and that your activity doesn’t duplicate.
7. Identify and plug any gaps – are there specific audiences you need to target?
8. Inclusive processes – consider all relevant equality and diversity and health inequalities issues.
9. Communication and messages – produce accessible and clear information about opportunities to engage and why.
10. Deliver your engagement plan – deliver your engagement activity in accordance with your project plan and timetable.
11. Evaluation and feedback – analyse  feedback from your engagement activity, produce a report of the findings and feedback outcomes to those you engaged with.
12. Meaningful engagement which influences decisions – how will the feedback be shared with decision-makers?