There is no doubt that PPI is ‘embedded’ in modern applied health research. There is also no doubt that having reached that stage, there is interest in pushing the envelope further through innovative models of contribution and co-production.
This blog is a short reflection on my experience of working as a PPI lead for the NIHR School for Primary Care Research (SPCR). If you don’t already know, SPCR is a chunk of NIHR funded ‘infrastructure’ and a collaboration between a number of primary care departments in England, with membership changing every 5 years. The direction of the SPCR is the responsibility of the Board, and as head of department, I was a member of that Board for a number of years
The SPCR has always ‘done’ PPI – all the constituent departments have their own PPI set ups, and the SPCR has involved patient contributors in a variety of cross-school activities, most notably as reviewers on funding rounds.
Like all NIHR infrastructure, SPCR gets regularly reviewed, and we have had much positive feedback over the years. However, a detailed and critical review of the SPCR PPI arrangements a few years ago did cause the Board to reflect on our practice – and one of the responses was to have a Board member as lead for PPI
I like to think I have ‘earned my spurs’ in PPI, much of it in years of enjoyable interaction with our local PRIMER group. But I also learned my applied health research trade in a context (1995 onwards) where PPI was largely absent. Being a psychologist is also a mixed blessing – as the discipline (at least when I was a student) does tend to give you a somewhat jaundiced view of people and their decision-making.
So, what did we do? The SPCR is a particular context for change – a group of departments ‘flying in loose formation’, where clear levers for change are indirect. But NIHR infrastructure does come with funds, and that enabled us to find people and resources to push us in new directions.
I read a tweet recently (apologies to the unknown author) where someone distinguished two types of quality improvement in research: those who raise the baseline (making sure everyone does the basic stuff well), and those who raise the bar (through innovation at the top end).
We tried to do a little bit of both:
In terms of ‘raising the baseline’, one of the core strengths of the SPCR is the ability to share good practice, and we worked hard to bring our people together to do that. No one department has the monopoly on good practice, and we all use PPI in different contexts and with different populations – so it is good to share. One of the departments within the SPCR (Keele) was also a pilot for the new UK Standards for Public Involvement. Sharing the fruits of that experience across the departments will be critical.
In terms of ‘raising the bar’, we also funded individual departments to develop innovative work with their PPI groups, to help these groups try new things and reach out to new groups. Departments have responded in various ways, including internal audits to identify the current state of their PPI activity and the way its impacts on their strategy, improving PPI support pre-funding, expanding work on inclusion (children, people of working age and from ethnic minorities) and strengthening the training of researchers and contributors.
We also ran competitions (https://www.spcr.nihr.ac.uk/PPI/spcr-PPIE-funding-calls) for involvement, engagement and dissemination, to encourage creative models of working, and help people introduce new ways of doing things.
Summaries of funded work can be found on the School’s website:
The other benefit that the funding brings is good people – our efforts in PPI have been wonderfully supported by our PPI officers – originally Emma Palmer-Cooper (@dr_emmaclaire) and now Esther van Vliet (@E_vVliet). They are from a different generation to me and the rest of the Board, have developed their ideas in a different context, and less hide bound in their thinking. A key skill for me has been getting out of their way and letting them drive this work forward
I have stepped down from the role now, and I hope my successor can continue to channel the enthusiasm and creativity of people in the SPCR to take us into new territory in PPI