Seventeen months after primary care groups (PCGs) were introduced to improve local health services, they are still struggling to come to terms with their mandate to get the general public on board. Ministers have warned them that patients and other NHS users will no longer tolerate a paternalistic health service that pays lip service to public involvement. The message is clear: PCGs (which are responsible for buying health services for the area they represent) not only have to make sure that local communities are consulted before decisions are made, but that they are involved. The same goes for primary care trusts (PCTs), introduced in April this year, which are similar to PCGs, but have the power to provide services for their local residents, as well as buy them from other agencies (such as the local hospital).
But the reality is that public involvement is still a long-term goal for most PCGs and PCTs. According to a recent study by the King's Fund, the independent health policy institute, it comes way down the list of priorities of most chief executives. The report says: "Their energies are focused on infrastructure, finance, developing primary care and clinical governance."
Anne Taylor, chief executive of Feltham PCG in west London, points out that it costs money (and time) to involve the public, but that the government has not made any specific funds available. She says: "To get effective public involvement, we need money for a decent venue for meetings with disabled access and a T-loop for the hard of hearing. It would also be nice to offer tea and sandwiches."
One organisation that has just received some money (£108,000) from the Department of Health is the National Association of Patient Par ticipation, a charity that helps to set up patient groups in GP practices. Joe Corkill, its chairman, explains that although the money will go to support the group's normal work, the funding for the three-year project was awarded in recognition of the extra demands on its services by PCGs and PCTs.
Those demands are an indication that both PCGs and PCTs are taking public involvement seriously - something borne out in a study by the Health Services Management Centre at the University of Birmingham. It shows that once PCGs and PCTs sorted out their internal structure, they turned their attention to developing ways of involving service users and the public. Not always an easy thing to do, according to Taylor. She says: "It can be difficult to engage the public. How do we empower people to know about their health?"
Alison Shea, chief executive of Hammersmith PCG, also in west London, agrees, but believes that the only way is to promote initiatives around people's health. She says: "We are holding public meetings, and have set up a website and produced newsletters about what we're doing for the health of local residents."
But many lay members feel frustrated with progress so far. Roy Latham, the lay representative on the Kent Weald PCG, says: "Everything seems to have taken a long time, although we are getting there now. We have just set up a lay panel made up of 109 members of the public who have been invited to our first meeting in September." A couple of months ago, he also started a public involvement sub-committee with members of the local authority and voluntary services representatives to discuss how best to consult with the community.
Other PCGs are also starting to make progress, and seem prepared to cough up the necessary funds. Brent ford, Chiswick and Isleworth PCG in west London spent £6,000 earlier this year on a research project asking people what they thought were the most pressing health issues in the area. It has also just invested £7,000 in a hand-held, electronic voting system called Teamworker, similar to the device used on the ITV programme, Who Wants to be a Millionaire, so that audiences can vote anonymously at public meetings held by the PCG.
But despite all the government's exhortations to PCGs and PCTs to involve the public, it has just announced the abolition of Community Health Councils (CHCs) in its national plan. Known as the patients' watchdog since their inception in the 1970s, CHCs have been able to share their skills and expertise with local PCGs and PCTs trying to find their way through the public involvement maze.
Donna Covey, director of the Association of Community Health Councils, says they have been involved in at least 30 different projects with local PCGs and PCTs. She argues that "by and large PCGs have been very open to help. There are a few patchy areas where the PCG has restricted CHC involvement at public meetings, but they are a minority."
Covey is critical of the focus on acute services in the government's proposals, which want the introduction of a nationwide patient advisory and liaison service based in hospitals. She argues: "The government's plan is structured in such a way that it will not work as well for patients as the current system. Abolishing CHCs does not follow naturally from what they have been talking about, and we need to talk through with them what is in the best interests of patients in the long run."
• Alison Clarke is a freelance journalist who is a lay member of the Middlesbrough and Eston PCG
