Note: Some sections of this case study refer to clinical commissioning groups (CCGs). On 1st July 2022, integrated care systems (ICSs) took over statutory commissioning responsibilities in England, and CCGs were closed down.

The idea

Give GPs and practice teams the head-space to redesign their approaches to manage growing workload better, and bring whole practice teams together to co-design change projects that can achieve sustained large scale change.

Change at individual practice level

It was Doncaster CCG that first offered individual practices the opportunity to participate in Productive General Practice (PGP) Quick Start and the General Practice Improvement Leads programmes.  The former gives practices on-site, hands-on support to help release time for care, whilst the latter helps individuals build the skills and confidence to support others to make changes.

A number of practices in Doncaster participated in the programmes and impact started to emerge with teams demonstrating reductions in DNAs, releasing GP time through better management of correspondence, and helping reduce the number of inappropriate GP appointments.

When the federation was established in 2017, it was agreed that a key role for it would be to support practices to continue and build momentum within the quality improvement arena. In October 2017, PCD hosted a local Time for Care showcase event where examples of success from the PGP Quick Start and the General Practice Improvement Leads programmes were presented back to an audience of peers.  This increased the appetite for change across practices and led the federation to run a Fundamentals of Change and Improvement programme, where staff could learn step-by-step how to use quality improvement tools and techniques and apply them in their practice.

Developing a more collaborative approach to change

Keen to consolidate the good work already happening and engage more practices in quality improvement, the federation wanted to bring practices together to take a more collaborative approach to learning and improvement.  Teams were offered the opportunity to participate in the Learning in Action programme, which gives practices the chance to work together on projects in groups and support each other to make changes.  Nine practices participated and worked collaboratively to achieve change.

• Relationships between practices were formed or strengthened with staff from a range of roles connecting and starting to network; previously this was only happening on a limited basis across the federation.
• Teams shared ideas and experiences of what was working well in their practice to help others tackle issues they had already successfully overcome. Protocols, templates and policies were willingly shared, saving teams time and effort in creating these resources from scratch.
• The group created a safe environment where everyone could get objective and constructive feedback from their peers in a supportive way.

Recognising the role of the federation and other emerging primary care leaders within Doncaster in driving continuous improvement, PCD worked with the Time for Care team to offer further development at the end of 2018, in the shape of Strength Deployment Inventory (SDI) workshops. These sessions afforded PCD Board Directors, team members, and interested practice colleagues the opportunity to understand motivations and behaviours on a deeper level, and strengthen their collective capability as a result of this.

Having worked on individual practice projects and then within groups, the federation felt its practice teams were equipped with the skills to lead larger scale change across neighbourhood networks.  These neighbourhoods are determined on the way the community teams are organised (district nurses, social workers, community officers, therapy workers), with practices grouping themselves in the same neighbourhoods for the purposes of representation on the federation Board.

The Time for Care team facilitated a series of workshops for the federation across four neighbourhood network areas that were attended by key system stakeholders including the CCG, commissioners, social care, education and housing.  The workshops were a significant step towards large scale change projects starting to take shape across primary care in Doncaster, with a ‘bottom up approach’.

• Important connections with stakeholders across the neighbourhoods were made regarding how to work together.
• Conversations progressed at a system-wide level about integrated Primary Care Networks.
• The networks prioritised projects to work on e.g. develop stronger relationships with GPs/other NHS providers, Local Authority Community Led Services pop-up hubs in general practice, co-location of mental health teams.

The workshops generated energy and enthusiasm for change on a whole-system, collaborative level.  Further work is now taking place to drive the projects forward and build on the relationships formed.

Impact

• The programme gave staff the skills and confidence to make changes that have benefited their teams, patients and wider general practice community.
• The St Vincent Practice – through better active signposting has released 25% of inappropriate GP appointments, giving GPs more time with the patients who need their care and patients easier access to appointments.
• Dunsville Medical Centre – by changing the times it sent text messages to patients to remind them of their appointment, the practice reduced GP DNA rates by 34%.
• Kingthorne Group Practice – released 12 hours of GP time over one week through better management of correspondence, for GPs this is delivering a more manageable workload.
• There is wider growing engagement and increasing integration with the CCG, commissioners and other system partners, demonstrating a real commitment to work together. This is an important step forward for the federation.
• Across the locality Primary Care Network leaders are starting to emerge, at all levels of general practice. The federation has already identified clinical champions who are now engaged with strategic planning across the network and the forward agenda.
• Collaborations between practices has increased, change is happening at a greater pace as practices are learning what is working successfully in other teams, rather than starting from scratch when trying to tackle similar issues.

“The Time for Care programme has enabled real and tangible improvements to patient care in Doncaster practices. It has given GPs the head-space to redesign their approaches to the growing workload and brought whole practice teams together to co-design change projects. We have now taken a significant step forward to progress system-wide conversations about integrated Primary Care Networks, and work towards change on a whole-system, collaborative level.” Laura Sherburn, Chief Executive, Primary Care Doncaster

“Attending the Time to Care sessions has brought fun, friendships and unearthed new challenges.  I have been able to work more closely with my practice manager, and network with other likeminded practices locally.” Rachel Hubbard, GP, Bentley Surgery

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.