Conceptualising patient and public engagement and involvement (PPEI) for commissioning and designing health and care services as situated learning.

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The commissioning (purchasing) and provider split that has dominated the English NHS since the early 1990s has blurred, even unravelled, as partnerships between organisations take on new forms to deliver integrated care. Commissioners, providers of NHS services, local government authorities and the voluntary and community sector (VCS) are working collaboratively to implement new models of health and (social) care services that are intended to be joined up and patient-centred. But where is the patient and public voice and how is engagement and involvement practised to encourage participation and further learning by all participants?The first aim of this proposed fellowship is to disseminate widely the findings from my PhD research which explored how commissioners, GP leaders and members of the public and service users engaged to make significant decisions about local health and care services. This is a fast-moving area and it is timely to focus on dissemination as legislative changes are planned to reflect the new landscape of clinical commissioning and service delivery within the English NHS. Some of the changes relate to the legal status of new network and system structures in terms of their accountability to place-based communities and engaging with people and communities using a co-productive approach.Secondly, I would then examine how my resultant iceberg model that reimagines patient and public engagement and involvement (PPEI) as a set of practices, could be applied as a conceptual map to aid learning. What lies below the surface performance is the knowledge and skills, the materials and infrastructures of PPEI and socially shared meanings. Using this lens, which is underpinned by social learning theory, I would like to encourage audiences to think differently about PPEI, that it is a constantly changing entity and not just a product or outcome to be measured for impact. There are leadership, trust, learning and partnership practices that could improve the construction of PPEI and participatory outcomes for commissioning and improving health and care services.The final dimension of the fellowship would be to undertake a small piece of research requiring NHS ethical approval to interview five or six patient engagement leads and/or commissioning support managers. They were not included in my original research and so the richness of their data would further enhance and refine the conceptual model and map thus improving its utility and impact.