Department of Health

Website of the Department of Health

Please note that this website has a UK government access keys system.

Patient and public involvement in developing primary medical services

  • Last modified date:
    8 February 2007

1. This note ( Gateway approval 3206) sets out advice for PCTs on complying with their duties under sections 7 and 11 of the Health and Social Care Act 2001 when developing primary medical services through GMS, PMS, PCTMS and APMS contracts. It should be read in conjunction with 'Strengthening Accountability - Involving Patients and the Public' and 'Overview and Scrutiny of health - Guidance'.

Duties under the Health and Social Care Act 2001

2. Section 11 of the Health and Social Care Act 2001 places a duty on NHS Trusts, PCTs and Strategic Health Authorities to make arrangements to involve and consult patients and the public in service planning and operation, and in the development of proposals for changes.

3. Section 7 of the Act places a duty on NHS organisations to consult overview and scrutiny committees (OSCs) on any proposal that is a 'substantial' development or variation. There is no definition of what constitutes 'substantial' - this is a matter for agreement between the NHS bodies and the OSCs involved.

Duty to consult in relation to Primary Medical Services

4. GMS, PMS, APMS and PCTMS contracts are underpinned by primary and secondary legislation which cannot be changed locally.  In addition, the new GMS contract has been agreed nationally between the BMA and the NHS Confederation and its terms, conditions and entitlements cannot be altered by PCTs.  However, the new duty on PCTs to provide primary medical services and the ability, through the new variety of contracting routes, for PCTs to plan services strategically, does allow for public and patient consultation and involvement in the reconfiguration of services locally.

5. For example, consultation cannot affect the right of GMS and PMS practices to transfer responsibility for out-of-hours provision to the PCT, which has been agreed nationally and underpinned by national legislation.  However, the PCT is likely to have a range of options in re-providing those services.

Methods and level of involvement and consultation

6. The diagram available from the link below sets out a continuum ranging from minimum to maximum involvement and provides ideas about involvement at a range of levels.  The level of patient and public involvement should be matched to the circumstances and context in which it is to take place.  In particular, it is important to be clear if people are being asked for their views on how the change can be best implemented rather than whether the change will happen.

Liaising with Overview and Scrutiny Committees

7. It is advisable for PCTs to engage early on with their local OSCs on key proposals for primary medical services. PCTs may want to agree with local OSCs criteria for when OSCs will be consulted and when they will be simply kept informed. Where the same issue arises across several PCTs or a proposal crosses PCT boundaries, it may be appropriate for those PCTs to approach the OSC together and SHAs may be able to help co-ordinate this approach. It will be important for OSCs to understand what cannot be subject to OSC consultation, eg the terms, conditions and entitlements of the new GMS contract itself.

Engaging with other patient and public involvement systems

8. PCTs should explore existing local mechanisms for engaging with patients and the public and ensure activity is complementary.  In particular, there should be early involvement with local Patient and Public Involvement Forums (PPI Forums).  Patient Advice and Liaison Service (PALS) may be a useful way of disseminating information and may also be able to highlight sources of dissatisfaction which could be addressed when reconfiguring services.

Conclusion

9. Ultimately it is for PCTs to consider on a case by case basis the level of involvement required.  However, it is advisable for PCTs to engage early on with local PPI systems and other key players and to build up effective relationships with them to facilitate involvement and reach common agreement on when and how consultation needs to take place.

Access keys