Background: Patient and public involvement in the development of health services is central to current government policy. In 2011 new financial incentives were introduced to promote the establishment of Patient participation groups (PPGs) which led to an increase in the number of PPG groups in England. PPGs are now well established in many practices. Objectives: The aim of this study was to explore PPG members’ views of the current and future challenges for Patient Participation Groups. Methods: Six focus groups were conducted with members of PPGs (n=31). They were audio recorded and transcribed verbatim. Qualitative analysis followed established principles with data coded and recoded into categories and themes. Results: Beyond acting as a conduit for patient feedback and as advisors to their practices, there was variation and some confusion about the roles of PPGs. All groups struggled to engage the interest of the patients they purport to represent. Their ability to improve quality of care was limited by several factors including the information available to them, their ability to interpret it, their perceived remit, and their relationship with the practice team. Many participants foresaw a future expanded role in relation to commissioning but this had yet to be defined in practice. Conclusions PPG members are willing and eager to contribute to service development at practice level. However, their roles were confined by the boundaries within which they were able to operate. Government policy literature and funding, through the Direct Enhanced Service payment, advocates input from patients into primary care. Yet this research demonstrates limitations in the support PPGs are able to provide to surgeries.