A more sustainable general practice for the future

Case study summary

South Warwickshire GP federation is made up of 34 general practices in the Midlands from areas including Warwick, Leamington Spa, Alcester, Shipston and Southam, covering 270,000 patients. The federation is seeking to develop quality improvement skills and expertise across its member practices, to help create a sustainable general practice provision. It hoped to achieve this by taking part in the Learning in Action element of the Time for Care programme, delivered by NHS England’s Sustainable Improvement team. The programme is part of the support available through the General Practice Forward View.

The idea

Use Learning in Action to broaden the skill base of practice managers and GPs, to include knowledge and skills in change and improvement that can be used continuously in general practice.  The federation held six workshops over six months for member practices to come together to collaborate and support each other to redesign their care and manage demand more sustainably.

Building a community that supports each other

Each workshop created a safe environment where practices could share the changes they were making within their own practice, what was working well and issues they were experiencing that they hoped member practices could help with.  The time and ‘head space’ the workshops provided allowed practices to share insights, personal experiences, processes and approaches from their own locality, that could either be adopted by others or act as valuable learning.  This openness and willingness to share created a community where practices were more supportive of helping each other make change happen.  This is something that did not happen before.

Developing skills in quality improvement

As practices worked through the programme they were introduced to a number of quality improvement tools and techniques such as the Model for Improvement, process mapping, tools for identifying opportunities for improvement and generating, prioritising and testing ideas.  Being able to take different techniques and approaches back to their practice to make improvements was significant.  Projects that had previously been put on hold were now progressing, changes were having a positive impact and time was being freed up for practices to deliver more services to the patients who need them.  Building quality improvement into the practice skill set meant teams can continuously improve the way they work and create a more sustainable provision.

Spread of resources

A whole host of resources were generated during the workshops, including resources developed by the practices themselves such as toolkits, Standard Operating Procedures and templates.  To maximise the learning and use of resources across the locality, the federation made them available to all member practices including those who were unable to attend (this is approximately 1000 staff).  It is now working to develop an extranet which will not only house all resources from Learning in Action, but other elements of the General Practice Development Programme too (Productive General Practice Quick Start and the General Practice Improvement Leaders programme).


  • GPs’ time is being used more effectively. At Waterside Medical Centre improvements in signposting have freed up inappropriate appointments, allowing GPs to spend more time with patients who need their care and less on those who are better dealt with by other practice staff.  With 30% of the federation’s GPs approaching retirement age, making working life more fulfilling could influence their decision to continue in practice.
  • Quality and efficiency has improved within member practices. At Bridge House Medical Centre time has been released by dealing with incoming paperwork better.
  • The federation is building a quality improvement skills base that did not exist previously, equipping practice teams with the skills and knowledge to make continuous and lasting improvements that can create a more sustainable general practice for the future.

Implementation tips

  • Make time from the outset to engage with practices, make it clear why this is a worthwhile programme and the benefits it can bring. The federation implemented a focused clinical communications campaign that was successful in securing buy-in.
  • If practices are reluctant to get involved, overcome any fears they may have by directing them to the case studies that evidence the programme does work.
  • Have a strong project lead in place to take the practices through the programme and a strong advocate to help keep the momentum going.
“There is huge value in bringing people with different skills and perspectives together. By working collaboratively they can learn from each other and become a more efficient and sustainable group of practices.  We have never done anything like this before, it has strengthened our collaborative approach that will work beyond Learning in Action.”
Tim Morris, Managing Director, South Warwickshire GP Federation