Patient and public engagement and involvement in clinical commissioning; socio-material pedagogies of partnership

  • Debbie Hatfield

    Student thesis: Doctoral Thesis


    Clinical Commissioning Groups (CCGs) in England are legally required to engage and involve service users (patients and carers) and the public. Direct engagement and partnership working with service users is an imperative for healthcare and healthcare improvement. It is less well-developed between clinical commissioners, who are predominantly general practitioners (GPs), and service users and the public.

    A focused ethnography approach was used to explore service user engagement practices for commissioning and leading health and care services with clinicians in the process of strategic clinical commissioning. Two CCG case study sites in the south of England were studied; one urban and the other rural. The primary research question was:

    What does it mean to work in partnership as clinicians and service users to commission and lead services?

    Secondary questions related to the nature of engagement and involvement practices, by exploring if partners in engagement relationships could be viewed as trusted peers. Three focus groups, 15 observations and relevant artefacts such as reports and minutes of meetings, and 13 face-to-face interviews were undertaken. All 21 informants were either service users, lay representatives on CCG Governing Bodies or GP clinical commissioning Leads, residing and/or working within the boundaries of the CCG communities.

    Four sets of situated learning practices were found as the CCG communities evolved to align with partnership working requirements for clinical commissioning; trust, leadership, learning and partnership. A practice theory lens was used to offer new insights with respect to the socio-material aspects of the situated learning. Using Wenger's seminal work on communities/landscapes of practice enabled a deeper analysis of the data examining participation, materiality, competence, boundary encounters and meanings. This articulated both the visible and hidden practices shaping patient and public engagement and involvement (PPEI) in the two CCGs.

    PPEI is a less well researched aspect of commissioning especially with GP clinical commissioners. Even less attention is paid to the socio-material context for this learning. The entangled and distributed quality of PPEI was found to be influenced by identification with present and past communities of practice and specific boundary encounters. The enablers, constraints and pre-requisites for PPEI in clinical commissioning were identified and these allow recommendations for both learning and practice.

    PPEI for clinical commissioning will persist with the newer Sustainability and Transformation Partnerships (STPs) in the English NHS. Leadership and commissioning curricula for GP and other healthcare professionals must be cognisant of the socio-material practices of partnership working.
    Date of AwardMay 2019
    Original languageEnglish
    Awarding Institution
    • University of Brighton
    SupervisorGordon Ferns (Supervisor), Kay Aranda (Supervisor) & Breda Flaherty (Supervisor)

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