title: The impact of patient participation direct enhanced service on patient reference groups in primary care: a qualitative study.
abstract: BACKGROUND
  NHS policy documents continue to make a wide-ranging commitment to patient involvement. The Patient Participation Direct Enhanced Service (PP-DES), launched in 2011, aimed to ensure patients are involved in decisions about the range and quality of services provided and commissioned by their practice through patient reference groups (PRGs). The aim of this exploratory study is to review the impact of the PP-DES (2011-13) on a sample of PRGs and assess how far it has facilitated their involvement in decisions about the services of their general practices.
  
  
  METHODS
  A qualitative methods design, using semi- structured interviews and focus groups, was employed to explore the experiences and views of GP practice staff (n = 24), PRG members (n = 80) at 12 GP practices, and other stakeholders (n = 4).
  
  
  RESULTS
  Wide variation in the role and remit of the participating PRGs was found, which broadly ranged from activities to improve practice resources to supporting health promotion activities. The majority of PRG members were unfamiliar with the PP-DES scheme and its aims and purpose. Stakeholders and practice staff felt strongly that the main success of the PP-DES was that it had led to an increase in the number of PRGs being established in the locality.
  
  
  CONCLUSIONS
  The PP-DES scheme has been a catalyst to establish PRGs. However, the picture was mixed in terms of the PRGs involvement in decisions about the services provided at their general practice as there was wide variation in the PRGs role and remit. The financial incentive alone, provided via the DES scheme, did not secure greater depth of PRG activity and power, however, as social factors were identified as playing an important role in PRGs' level of participation in decision making. Many PRGs have to become more firmly established before they are involved as partners in commissioning decisions at their practice.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Pollard
authors.affiliation: Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK. sa144@le.ac.uk.
authors.forename: Shona
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Fawn
authors.initials: F
authors.lastname: Harrad
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Lester
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Ainsley
authors.initials: A
authors.lastname: Cross
authors.affiliation: NIHR CLAHRC East Midlands, Leicester General Hospital, Leicester, UK.
authors.forename: Paula
authors.initials: P
authors.lastname: Wray
authors.affiliation: NIHR CLAHRC East Midlands, Leicester General Hospital, Leicester, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Smith
authors.affiliation: NIHR CLAHRC East Midlands, Leicester General Hospital, Leicester, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Locke
authors.affiliation: Healthwatch Rutland, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Sinfield
mesh_terms: D001291:Attitude of Health Personnel; D005246:Feedback; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D010358:Patient Participation / Q000379:methods*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D013222:State Medicine / Q000458:organization & administration* / Q000592:standards; D006113:United Kingdom