title: Primary care-led commissioning and public involvement in the English National Health Service. Lessons from the past.
abstract: BACKGROUND
  Patient and Public involvement (PPI) in health care occupies a central place in Western democracies. In England, this theme has been continuously prominent since the introduction of market reforms in the early 1990s. The health care reforms implemented by the current Coalition Government are making primary care practitioners the main commissioners of health care services in the National Health Service, and a duty is placed on them to involve the public in commissioning decisions and strategies. Since implementation of PPI initiatives in primary care commissioning is not new, we asked how likely it is that the new reforms will make a difference. We scanned the main literature related to primary care-led commissioning and found little evidence of effective PPI thus far. We suggest that unless the scope and intended objectives of PPI are clarified and appropriate resources are devoted to it, PPI will continue to remain empty rhetoric and box ticking.
  
  
  OBJECTIVE
  To examine the effect of previous PPI initiatives on health care commissioning and draw lessons for future development.
  
  
  METHODS
  We scanned the literature reporting on previous PPI initiatives in primary care-led commissioning since the introduction of the internal market in 1991. In particular, we looked for specific contexts, methods and outcomes of such initiatives.
  
  
  RESULTS
  1. PPI in commissioning has been constantly encouraged by policy makers in England. 2. Research shows limited evidence of effective methods and outcomes so far. 3. Constant reconfiguration of health care structures has had a negative impact on PPI. 4. The new structures look hardly better poised to bring about effective public and patient involvement.
authors.affiliation: 1Health Services Research and Policy Department,London School of Hygiene and Tropical Medicine,London,UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Petsoulas
authors.affiliation: 2Centre for Health Services Studies,University of Kent,Kent,UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Peckham
authors.affiliation: 3Centre for Research in Primary and Community Care,University of Hertfordshire,Hertfordshire,UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Smiddy
authors.affiliation: 4Centre for Health Services Studies,University of Kent,Kent,UK.
authors.forename: Patricia
authors.initials: P
authors.lastname: Wilson
mesh_terms: D026683:Advisory Committees / Q000458:organization & administration; D054976:Clinical Governance / Q000458:organization & administration; D004739:England; D058005:General Practitioners / Q000458:organization & administration* / Q000592:standards; D018166:Health Care Reform / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D006291:Health Policy; D006801:Humans; D007857:Leadership; D010358:Patient Participation / Q000379:methods*; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D013222:State Medicine / Q000458:organization & administration* / Q000592:standards
keywords: England; NHS; commissioning; community participation; health policy; public involvement; user involvement