In 2014 the National Health Service (NHS) in England released the Five Year Forward plan , envisioning a shift in power from health professionals to patients and the public. In response the Society and College of Radiographers (SCoR) produced the "Patient, Public and Practitioner Partnership within Imaging and Radiotherapy: Guiding Principles" (P4) document which was implemented within four domains of radiography practice; service delivery, service development, education and research . This project explored how these guidelines were implemented; and whether improvement to the quality and scope were needed, leading to making recommendations for updating the document. A mixed methods design was adopted with two phases. Phase 1 - a survey exploring use of the P4 document's guiding principles. There was no maximum number of participants to ensure inclusivity. Phase 2 - one focus group and four one-to-one interviews from the four domains . 626 participants completed the phase 1 survey. 18.85% (n=118) of participants were aware of the document and used it as a reference tool for practice, teaching, and research. 81.15% (n=508) of participants stated they were unaware of the document. Themes from phase 2; importance of service user involvement in service delivery and evaluation, resources to ensure service user involvement, suggestions to update the P4 document and use of the P4 document in radiographer education. Participants acknowledged guidance in the document was best practice. They reported more awareness of patients' needs and the effect this has on radiographers in supporting their needs. Participants recommended the document be given greater visibility. The voices of patients and the public must be heard within radiography practice. Feedback from this study can be used for the future development of the P4 document. [Abstract copyright: Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.]