'It is still coming from the centre and coming out': The material conditions adding to over-bureaucratised patient and public involvement for commissioning health and care in England.
'It is still coming from the centre and coming out': The material conditions adding to over-bureaucratised patient and public involvement for commissioning health and care in England.
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DOI：
10.1111/hex.13768
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发表时间：
2023-08
影响因子：
3.2
通讯作者：
Hart, Angie
中科院分区：
文献类型：
--
作者：
Hatfield, Debbie;Aranda, Kay;Ferns, Gordon;Flaherty, Breda;Hart, Angie
关键词：
了解在英国国家医疗服务体系（NHS）的背景下，重要性如何影响患者和公众参与（PPI）的委托和领导健康和护理服务。从2013年4月起，全科医生小组（gp）成为NHS临床委托小组（ccg）的成员，以评估需求并与当地社区一起获得核心卫生服务。自2022年7月起，综合护理系统（ics）承担了这一责任。国民保健制度的重组是由更有效和高效的医疗保健的承诺驱动的，并导致了在经济、政治和道德基础上PPI的悠久历史。很少有研究在临床调试中研究PPI，更少的是探索对重要性及其对PPI的影响的更真实的理解。在英国的两个CCG案例研究地点，重点人种志用于检查PPI的临床调试。三名CCG理事会非专业代表、九名GP专员和七名服务用户代表参加了焦点小组和/或接受了采访。在CCG会议上还进行了15次非参与性意见，并审查了相关的重要性。临床委托活动的重要性影响和塑造了PPI的性质。这些形式的物质性可能会削弱和颠覆依赖于信任、领导、学习和伙伴关系的有意义的参与和参与。国际集成系统的系统领导者应该考虑在PPI调试中涉及的中央驱动过程的重要性，以减少障碍并确保当地社区内有意义的伙伴关系。研究设计确保PPI在整个研究过程中与当代研究实践指导保持一致。项目指导委员会包括目前或最近在研究地点以外具有PPI临床调试经验的服务用户。PPI参与了最初的研究计划及其发展，包括本研究所依据的博士基金的竞标。所有人都参与评估数据收集的严谨性，解释研究结果，并确保项目忠于研究目标。两名成员也参与了研究结果的介绍。
To understand how materiality affects patient and public involvement (PPI) for commissioning and leading health and care services in the English National Health Service (NHS) context. From April 2013 groups of general practitioners (GPs) became members of NHS clinical commissioning groups (CCGs) to assess needs and procure core health services for and with local communities. Since July 2022, integrated care systems (ICSs) have subsumed this responsibility. NHS reorganisations have been driven by the promise of more effective and efficient health care and have led to a long history of PPI on economic, political, and moral grounds. Few studies researching PPI in clinical commissioning exist and fewer still have explored a more agentic understanding of materiality and its impact on PPI. A focused ethnography was used to examine PPI for clinical commissioning within two CCG case study sites in England. Three CCG Governing Body lay representatives, nine GP commissioners and seven service user representatives took part in focus groups and/or were interviewed. Fifteen nonparticipant observations were also carried out at CCG meetings and the associated materiality was examined. The materiality of activities involved in clinical commissioning influences and shapes the nature of PPI. These forms of materiality may dilute and subvert meaningful engagement and involvement that relies on trust, leadership, learning, and partnership working. System leaders in ICSs should consider the significance of materiality in centrally driven processes involved in PPI commissioning to reduce barriers and ensure meaningful partnerships within local communities. The study design ensured PPI throughout the research process in keeping with contemporary research practice guidance. The project steering committee included service users with current or recent PPI clinical commissioning experience outside of the study sites. There was PPI involvement in the original study proposal and its development including the bid for doctoral funds on which this study is based. All were involved in assessing the rigour of the data collection, interpretation of the findings and ensuring the project remained true to the aims of the study. Two members have also participated in presentation of the study findings.
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