Challenges and facilitators for patient and public involvement in England; focus groups with senior nurses


The concepts of patient and public involvement (PPI) have been recognized and linked with quality in health services internationally and in Europe. In England, for more than a decade, NHS policies have increasingly quoted patient-centred services. Limited evidence exists about the implementation of PPI policies and strategies within organisations; three studies only have explored health professionals’ perceptions of PPI. Although nurses’ positive support for patient and public involvement has been noted, comparatively little is known about senior nurses’ experiences of embedding PPI. A national consultation utilising three focus groups aimed to explore senior nurses’ perceptions of challenges and facilitators for PPI implementation. Four Strategic Health Authorities (SHAs) and eleven Primary Care Trusts (PCTs) in England, with fifteen senior nurses with leadership roles and direct PPI experience, participated. Nurses’ perceptions on patient and public involvement, challenges and facilitators for its implementation were discussed. Focus groups were digitally recorded and transcribed verbatim; anonymised transcripts were validated by participants and analysed with thematic analysis. Limited resources, patient representation and recruitment, complexities of implementing PPI and national policy changes were challenging. Commissioning limitations, lack of feedback on patient experience, limited staff awareness, negative attitudes, management of patients and public expectations constituted further challenges. Nursing role characteristics and informal involvement activities, PPI policy and cultural change, commissioning PPI competencies, related service frameworks, providing feedback on patient experiences to staff and recognition of involvement benefits were recognised as facilitators. Findings provided new insights into senior nurses’ experiences and evidence that progress towards meaningful, effective PPI remains slow. However, recognition of existing nursing role characteristics and potential delivery problems created by expanded nursing roles, informal PPI practice and internal organisational sharing of patient feedback may bring an “emerging productive partnership” with nurses enabling and contributing to effective PPI.

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Boudioni, M. and McLaren, S. (2013) Challenges and facilitators for patient and public involvement in England; focus groups with senior nurses. Open Journal of Nursing, 3, 472-480. doi: 10.4236/ojn.2013.37064.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] World Health Organisation (1986) Ottawa charter for health promotion. The move towards a New Public Health. WHO, Ottawa.
[2] World Health Organisation (1997) The Jakarta declaration on leading health promotion into the 21st century. 4th International Conference on Health Promotion, Jakarta, 21-25 July 1997.
[3] World Health Organisation (2009) The European Health Report 2009: Health and health systems. WHO Regional Office for Europe, Copenhagen.
[4] Fallberg, L. and Mackenney, S. (2004) Conclusion. In: Mackenney, S. and Fallberg, L., Eds., Protecting Patients’ Rights? A Comparative Study of the Ombudsman in Healthcare, Radcliffe, Oxon, 137-148.
[5] Department of Health (2003) Strengthening accountability: Involving patients and the public. DH, London.
[6] Department of Health (Farrell, C.) (2004) Patient and public involvement in health: The evidence for policy implementation. DH, London.
[7] Department of Health (2004) “Getting over the wall” How the NHS is improving the patients’ experience. DH, London.
[8] Department of Health (2010) Equity and excellence: Liberating the NHS. The Stationary Office, London.
[9] Department of Health (2007) World class commissioning: Vision summary. DH, London.
[10] Department of Health (2008) High quality care for all: NHS next stage review final report. DH, London.
[11] Involve (2005) People & participation: How to put citizens at the heart of decision-making. Involve, London.
[12] Department of Health (2008) Real involvement: Working with people to improve services. DH, London.
[13] Coulter, A. and Ellins, J. (2006) Patient focused interventions: A review of evidence. Quest for quality and improved performance (QQUIP). The Health Foundation, London.
[14] Coulter, A. and Ellins, J. (2007) Effectiveness of strategies for informing, educating and involving patients. British Medical Journal, 335, 24-27.
[15] Nilsen, E.S., Johansen, M., Oliver, S., Oxman, A.D. (2010) Methodological considerations involved in developing healthcare policy and research, clinical practice guidelines and patient information material. Cochrane Collaboration, John Wiley & Sons, New Jersey.
[16] Sang, B. (2009) Chapter 22. User involvement: The involved and involving community health care nurse. In: Sines, D., Saunders, M. and Forbes-Burford, J., Eds., Community Health Care Nursing, Wiley-Blackwell, Oxford, 352-362.
[17] National Centre for Involvement (2007) A baseline assessment of the current state of patient and public involvement in English NHS trusts. NCI, Warwick.
[18] National Centre for Involvement (2008) The current state of patient and public involvement in NHS trusts across England; findings of the national survey full report. NCI, Warwick.
[19] Picker Institute Europe (2007) Patient and public involvement in primary care commissioning. Picker Institute Europe, Oxford.
[20] National Audit Office (2007) Improving quality and safety progress in implementing clinical governance in primary care: Lessons for the new primary care trusts. The Stationery Office, London.
[21] Healthcare Commission (2009) Listening, learning, working together? A national study of how well healthcare organisations engage local people in planning and improving their services. Commission for Healthcare Audit and Inspection, London.
[22] Chishold, A., Redding, D., Cross, P. and Coulter, A. (2007) Patient and public involvement in PCT commissioning: A survey of primary care trusts. Picker Institute Europe, Oxford.
[23] Fudge, N., Wolfe, C.D.A. and McKevitt, C. (2008) Assessing the promise of user involvement in health service development: Ethnographic study. British Medical Journal, 336, 313-318.
[24] Picker Institute Europe (2009) Patient and public engagement. The early impact of world class commissioning: A survey of primary care trusts. Picker Institute Europe, Oxford.
[25] Boudioni, M. and McLaren, S. (2009) Nurses and patient and public involvement: A consultation in four strategic health authorities in England. London South Bank University, London.
[26] Barbour, R.S. and Kitzinger, J. (1998) Developing focus group research: Politics, theory and practice. Sage, London.
[27] Darlington, Y. and Scott, D. (2002) Qualitative research in practice: Stories from the field. Open University Press, Buckingham.
[28] Boyatzis, R.E. (1998) Transforming qualitative information: Thematic analysis and code development. Sage, London.
[29] Braun, V. and Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101.
[30] Department of Health (2007) Essence of care: Benchmarks for care environments. Department of Health, London.
[31] Department of Health (2004) The NHS knowledge and skills framework: Development and review process. Department of Health, London.

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