Building capability for quality improvement across a GP federation

Case study summary

Quay Health Solutions GP Federation in North Southwark created a team of service improvement leaders made up of GPs, nurses, practice managers and reception staff. The move was seen as a vital way to build capability, capacity and confidence in quality improvement within all 20 member practices, with a goal to help achieve sustainable improvements and build confidence in managing change across the federation.


The idea

Working in partnership with NHS England’s Sustainable Improvement team, the federation embarked on a programme of change. Each member practice was invited to be part of the programme, which included the opportunity to develop local improvement leaders within member practices.

Each improvement leader would be released from their practice to attend the General Practice Improvement Leaders programme, to learn how to use a number of tools and techniques in quality improvement, and how to facilitate the use in everyday practice. During the programme, which is run as three two-day workshops, participants would actively work on a live project they had brought with them.

A Service Level Agreement between the federation and member practices set out what would be expected of participating practices in terms of time, commitment and contribution. In exchange for attending the programme each improvement leader was released for 12 days . This time was shared between spreading their learning within their own practice and among member practices, as well as helping to deliver the Time for Care learning sessions. 17 out of the 20 member practices signed up.

The Time for Care learning sessions take a collaborative approach to learning and improvement. This programme commenced after the first workshop for the new improvement leaders had been completed.

Role of improvement leaders

Improvement leaders came from a variety of member practices and roles across the federation, ranging from practice managers to IT leads, through to care navigators and GPs. On completing the programme each leader:

  • Returned to their practice to deliver the improvement project they had chosen and share what they had learned with their practice team.
  • Supported other practices in the federation they had been mapped to, either to get them going with their improvement projects or generally share tools and techniques that help drive quality improvement.
  • Helped the federation deliver the Time for Care learning sessions. This included facilitation support, leading table discussions and providing general learning in quality improvement.


  • Capability and capacity in quality improvement has increased across the federation enabling innovation, improvement and the transformation of services to happen at a greater pace than before.
  • Improvement projects that were previously on hold/had difficulties getting started are now progressing, with the knowledge and support available from the quality improvement leaders.
  • Learning is no longer limited or concentrated among a few individuals within the federation. It is spread across member practices in North Southwark making it easier for practices to access quality improvement knowledge and expertise.
  • Individual practices are already seeing the impact. For example, as a result of analysing frequent attenders on a sample size of 11 patients (patients with more than 10 annual face to face GP appointments), one practice has to date:
    • Released 81 appointments or 810 minutes, equivalent to 13.5 hours to date (as at June 2017).*
    • Projected 164 released appointments or 1,640 minutes, equivalent to 27.3 hours per year (6 Sessions).*

* Data demonstrates very early results.  As part of its ongoing aim to measure improvement the practice will continue to monitor and identify further impact data.

“We were so impressed with the Quality Improvement Facilitator Training programme we had done previously, that we asked the Sustainable Improvement team to help our federation design and deliver a development programme for our member practices. It is important for us to build the skills and capabilities across roles in the practice. This together with the earlier leadership development programme will make a big impact on our federation’s sustainability.”


Tilly Wright, Practice Manager and Director Quay Health Solutions GP Federation

Implementation tips

  • Communication and engagement was vital to bringing member practices on board. The service improvement and communications teams took every opportunity to discuss the programme with practices to help secure buy-in, for example,  engaging with the  Quay Health Solutions board, attending member practice meetings, attending the local Practice Manager’s Forum and Nurses Forum, as well as speaking to staff during practice visits.
  • A Service Level Agreement set out what the federation ‘ask’ was of member practices and what they received in return. This clearly set out expectations on both sides for the time and commitment required to make the programme succeed.
  • The federation’s service improvement team helped provide support to those practices where there was no service improvement lead, ensuring improvement was driven across the whole federation.