Inequalities in Patient Participation: Association between general practice engagement with patient participation groups in deprived versus affluent areas and CQC ratings

Problem

The NHS constitution emphasises the importance of patient participation in healthcare service delivery. Patient participation in the form of having a Patient Participation Group (PPG) has been a contractual obligation in English general practice since 2015. The Care Quality Commission (CQC) have a role in monitoring this in terms of how general practices respond to patients and PPGs and this is a key aspect of their ‘responsive’ and ‘well-led’ quality statements. Despite this, research into the coverage and effectiveness of PPGs is limited. The most recent data from 2016 estimated that one quarter of GP practices did not have a PPG, particularly in urban areas. Therefore, we aimed to explore the relationship between the coverage and quality of PPGs and the general practice level of deprivation, geographical location, and overall CQC rating.

Approach

The most recent full-inspection CQC report was hand searched for all general practices in the most (Level 1) and least (Level 10) index of multiple deprivation (IMD) area deciles for all three Integrated Care Systems (ICS) across Yorkshire and Humber. Quantitative (CQC rating and presence, partial, or absence of a PPG) and qualitative data (descriptive details regarding the structure and function of the PPG) was extracted and managed in Microsoft Excel. Quantitative analysis with Fishers Exact Test compared the presence or absence of a PPG with level of deprivation, geographical area, and CQC rating. Thematic analysis grouped qualitative data reporting the quality of the structure and function of PPGs.

Findings

A total of 123 general practice CQC reports were included, with 87 in level 1 and 36 in level 10 IMD areas. Overall, 99 practices (81.1%) had a PPG, 16 practices (13.1%) did not have a PPG, and seven practices (5.7%) had a partial PPG. General practices in IMD level 1 areas were significantly less likely to have a PPG compared to IMD level 10 areas (p=0.0376). No significant difference in PPG coverage was found between ICS areas. There was a lack of association between CQC rating and the presence or absence of a PPG. High functioning PPGs were described as influencing a range of areas including staff recruitment and training, infrastructure, communication systems, appointments and accessibility, health promotion and education, and fundraising.

Consequences

General practices within deprived areas are significantly less likely to have a PPG. High quality PPGs undertake activities which potentially improve patient experience and population health. With fewer PPGs, and hence patient voice in more deprived areas this is likely to further increase health inequalities. Despite PPGs being a contractual obligation, there was no association between having a PPG or not and the general practices’ CQC ratings. This lack of accountability is a risk to the sustainability of PPGs, and potentially quality and equity of care.