A step closer towards improving local services – Warrington CCG, North West

Case study Summary

Warrington CCG was made up of 26 practices and 135 whole time equivalent GPs serving a practice population of 219,463. On 1st July 2022, CCGs were replaced by integrated care systems (ICSs). ICSs took over statutory responsibilities for commissioning.

The former Warrington CCG participated in the Learning in Action programme to help its practice networks work together more and make improvements to local services. The programme was delivered by NHS England and part of the Time for Care support available through the General Practice Forward View.

The idea

Work together in practice networks to use quality improvement tools and approaches to improve local services.

Making improvement at practice and network level

The CCG had seven groups of practices that were formed into networks in Warrington, each network varied from between 3 to 6 practices.  The networks met every month to drive improvements and work through steps in the former CCG’s Maturity Model, which commissioned all practices to work together.  All networks achieved Step 1 Leadership, and through Learning in Action wanted to work through Step 2 – Improving local services.

Practices were given the option to work on two High Impact Actions, one which they could work on with their own practice team and the other to work on at network level.  Depending on what the most pressing local issues were projects varied from freeing up clinical and admin time by reducing processing of unnecessary patient correspondence, to developing joint policies and procedures to release GP time by reducing inappropriate home visits.

Over six months the networks collectively attended three programme workshops to learn about various quality improvement tools and techniques, how to apply them in practice, share their learning and progress on projects, and support each other to make changes.

Driving projects in practice

In between workshops practices had the support of the Primary Care Team at the former CCG and programme facilitators from the Time for Care team, who helped them drive forward their projects by providing hands-on in-practice support.  For example, support with creating run charts for the data that they had gathered.

Working together to make improvements as networks

Working on network projects helped practices to work together on tackling common issues.  For example, the Central North network identified a common theme across its five practices of excessive and inappropriate use of GP appointments for young children presenting with minor and self-limiting ailments.  The network identified there were other services available to young families that would be more appropriate however, the practice teams and patients were not all aware of these.  As a result, these services were added to the networks signposting options in all five practices.

East network created a partnership/collaborative way of working with Public Health and Community Lifestyle Services, to jointly address health inequalities in the network targeted lifestyle interventions for patients with a Body Mass Index (BMI) between 25 – 35.  One of the changes made across the network was that lifestyle coding was standardised to improve data collection and ongoing monitoring.

Building on existing quality improvement skills and knowledge

Some practices in the networks already had prior knowledge and experience of using quality improvement tools and techniques.  Through the programme they were able to refresh their use of tools such as Plan Do Study Act cycles and process mapping, as well as being introduced to new tools such as stakeholder engagement and commitment mapping.

Collectively building quality improvement capability and capacity across the networks strengthened closer working and helped develop staff skills and experience in change expertise.


  • The work the networks have done has helped them progress to Step 2 – Improving local services, of the CCG’s Maturity Model. The knowledge and skills gained through the workshops will be valuable to the future primary care pathways which are being developed.
  • Working relationships between practices has improved putting them in good stead for working as Primary Care Networks.

Chapelford Medical Centre has 2 whole time equivalent GPs and a patient population of 5,000.  Managing demand via a nurse telephone triage model has helped the practice achieve the following efficiencies.

  • Release 25 GP appointments a week.
  • Reduction in the number of calls GPs have to make.
  • GPs have reported they are feeling more ‘in control’ of their daily demands.
  • The practice’s Patient Participation Group is fully supportive of the changes and championing the new approach as they recognise the benefits for patients in terms of access.

Westbrook Medical Centre has 6 whole time equivalent GPs and a patient population of 10,000.  Implementing active signposting has delivered the following improvements.

  • Released 177 inappropriate appointments over two months.
  • On average 3.6 hours has been released per week, helping GPs to catch up with their paperwork.
  • All GPs agree this has made a huge difference to their working days.
  • Receptionists feel more empowered to help patients by offering alternative services to GP appointments that are more appropriate for them.
  • Patients are receiving a better service where they are now able to see their GP in a timelier manner or be directed to a service that better suits their needs.

If you would like to find out more about participating in the Learning in Action programme, along with details on how to apply, visit our web page.