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

自20世纪90年代初以来，委托（采购）和提供者的分离一直主导着英国国民健康保险制度，随着组织之间的合作伙伴关系采取新的形式来提供综合医疗服务，这种分离已经变得模糊，甚至已经瓦解。专员、国民保健服务提供者、地方政府当局以及志愿和社区部门正在合作实施旨在联合起来并以病人为中心的保健和（社会）护理服务新模式。但是，耐心和公众的声音在哪里？如何实践参与和参与，以鼓励所有参与者的参与和进一步学习？这个提议的奖学金的第一个目的是广泛传播我的博士研究的结果，该研究探讨了专员，全科医生领导和公众成员以及服务用户如何参与对当地卫生和保健服务做出重大决定。这是一个快速发展的领域，随着立法变化计划反映英国NHS临床委托和服务提供的新格局，关注传播是及时的。其中一些变化与新网络和系统结构的法律地位有关，涉及它们对当地社区的问责以及使用共同生产方法与人民和社区接触。其次，我将研究我的冰山模型如何将患者和公众的参与和参与（PPEI）重新想象为一套实践，作为一个概念图来帮助学习。在表面表现之下的是知识和技能，PPEI的材料和基础设施以及社会共享的意义。通过这个以社会学习理论为基础的视角，我想鼓励观众以不同的方式看待PPEI，它是一个不断变化的实体，而不仅仅是一个衡量影响的产品或结果。有一些领导、信任、学习和伙伴关系的做法可以改善公私合作的建设，并在委托和改善保健服务方面取得参与性成果。该奖学金的最后一个方面是进行一小部分研究，需要NHS伦理批准，采访五到六个患者参与领导和/或委托支持经理。他们没有包括在我的原始研究中，因此他们的数据的丰富性将进一步增强和完善概念模型和地图，从而提高其效用和影响。

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.