Case study summary
Following a robust public consultation, Durham Dales, Easington and Sedgefield Clinical Commissioning Group (DDES CCG), decided on a new service model for urgent care.
The model would move urgent care activity back into general practice and federation led primary care services, accessible between 8am – 8pm on weekdays and 8am – 1pm on weekends. To enable a smooth transition of services that would go live 1 April 2017, the CCG looked at developing a preparatory service specification on improving access to general practice, which would include improvement plans for practices and federations.
A task and finish group to aid with the development of the service specification was established to ensure it was realistic for all parties, whilst meeting the objectives of the service. All practices and federations were aware of what they were expected to deliver however, they needed support to help them work on their implementation plans to make sure they were prepared for the new services going live on time. The CCG saw NHS England’s Sustainable Improvement team’s Time for Care programme, a programme that is part of the support available through the General Practice Forward View, as the right support the practices and federations needed.
Time for Care uses a collaborative approach to learning and improvement, focusing on the 10 High Impact Actions (ways of working in general practice that have been found to simultaneously release clinician time and improve care for patients). As the project covered five of the 10 actions (active signposting, develop the team, personal productivity, social prescribing and support self-care), the CCG saw the programme as providing the support their practices and federations needed.
Development Advisers from the Sustainable Improvement team attended an engagement event followed by two Time for Care ‘learning in action’ workshops over a four month period. They were attended by practices and federations and provided vital protected time away from busy daily roles to focus on the improving access project, enabling important peer to peer learning in an environment that encouraged sharing. The CCG then took the opportunity to further align the learning and action to their local priorities to improve access and held a short celebratory event in to maximise the impact and share the learning and insights.
For the first time all in the locality were given a chance to learn from each other as to what was working within their organisations and some of the pitfalls they experienced/lessons learned. This was a significant phase of the work as many good projects were already being undertaken across practices and the workshops gave an opportunity to share this learning in an efficient and effective way, allowing practices to take learning back to their practice and implement change, all which would contribute to helping the new service model go live on time. Some of the examples included a practice focusing on the role of healthcare navigators, ensuring patients were coordinated and directed to the right service. Another practice looked at reducing DNAs where a local marketing campaign was rolled out to raise awareness amongst the public about the problems DNAs can cause and how it impacts the practice and other patients.
The Sustainable Improvement team introduced various tools and techniques from quality improvement for participants to use. The Plan, Do, Study, Act cycle, which puts focus on improvement in a logical sequence, was significant in helping ensure that plans put in place were appropriate to individual practices achieving their goals, as well as the aims of the overall improving access project.
- There has been successful and effective collaborative working between the CCG, practices and federations.
- All practice leaflets now contain standardised information on access, this means there is consistency across practices and all patients receive the same information.
- There is an agreed definition of urgent and routine appointments set out in the leaflet.
- Ensure all practices and federations are on board with the idea of collaborative working and embracing improvement tools and techniques.
- Have clear agendas set for each workshop so participants understand what is expected in terms of contribution and intended outcomes.
- Make sure you get the right stakeholders involved from the start.
From the outset it was clear that we all had to work together if we were going to make the project a success, that meant collaborative working was going to be vital. The Time for Care learning in action programme brought together the CCG, practices and federations in an environment where we could share and learn with each other. This helped us work through small cycles of change that when brought together and shared, delivered a significant project of change for the CCG.”
Joseph Chandy, Director of Primary Care, Partnerships and Engagement