Making quality improvement a way of working in general practice – Gloucestershire CCG, South West

Case study summary

Gloucestershire CCG is made up of all 76 GP practices in Gloucestershire, serving a population of over 646,000 registered patients. Following the announcement of the General Practice Forward View, the CCG wanted to look at rolling out a quality improvement programme that would support practices to collaborate, improve the quality of services delivered to patients and help GPs release time for care. To help achieve this it took up the Time for Care programme delivered by the Sustainable Improvement team, NHS England. The programme is part of the support available through the General Practice Forward View.

 

The idea

Equip practice staff with skills and quality improvement knowledge to help develop more efficient and effective ways of working, and embrace a collaborative approach to sharing and learning.

Developing the fundamentals of change

Working with the Sustainable Improvement team at NHS England, the CCG built a programme containing individual, practice and cluster elements, as shown on the diagram below.

The CCG first offered all practices the opportunity to participate in the Fundamentals of Change and Improvement programme (individual level offer on the diagram above). This two-day programme shows participants step-by-step how to use a number of quality improvement tools and techniques that help build skills and confidence to make changes in practice, whilst applying the learning to a live project they brought along to work on. Projects varied depending on what participants wanted to focus on such as repeat prescribing, managing clinical correspondence or triage processes.

Participants were introduced to a number of quality improvement tools and approaches such as the Change Model for Health and Care and the Model for Improvement. At the end of the two days participants had created individual project plans to drive forward their project, setting out actions they could start working on as soon as they returned to their practice.

A number of key points were highlighted during the programme.

  • Teams recognised that the issues they were facing were similar to other practices and by learning and sharing ideas they were not alone and could find solutions quicker e.g. scanning and repeat prescribing issues.
  • Communication improved between staff and partners, where both gained a better understanding of each other’s workloads and how they could support one another e.g. day to day problems that GPs struggle with such as managing correspondence could be dealt with more efficiently by other members of the team.
  • A focus on improving the process can help depersonalise the presenting problems.

A quick start to making improvements

The Fundamentals of Change and Improvement programme helped clinicians and practice managers to have a quality improvement mind-set that had not previously existed. This gave them the confidence and enthusiasm to embrace the next opportunity that was offered to them, the Productive General Practice (PGP) Quick Start programme (practice level offer on the diagram). Also part of Time for Care, PGP Quick Start is an on-site, hands-on, short term support package that helps practices to work on small scale improvements which contribute to time savings.

Over 30 practices took up the programme and selected which areas they wanted to focus on to address issues that regularly caused staff frustrations e.g. inappropriate appointments and unhelpful variation in processes. With the support of an experienced improvement facilitator, teams worked through the issues and developed and tested new ways of working. All practices came together in group based learning sessions, where they shared what they had learnt during the programme, further enhancing the chance to collaborate, share improvements and good ideas and plan their next improvement area.

Impact

The following shows examples of some of the impact that has already been achieved in the practices.

  • Gloucester Health Access Centre has 4 whole time equivalent GPs serving a population of approximately 7,000 patients. A more efficient process for dealing with incoming paperwork which has:
    • released an initial 29% of GP admin time, an average of 3 hours per week per whole time equivalent
    • given GPs time back that they can now spend with patients
    • developed a process where patient notes are more comprehensively completed and more information noted in their records.
  • By exploring new ways of ensuring patients receive the most appropriate consultation, the practice is now offering phone consultations as the default mechanism for initial GP contact, which has:
    • released an initial 5 per cent of GP consultation time, an average of 1.3 hours per week per whole time equivalent
    • allowed GPs to spend the released time face to face with their most vulnerable patients, giving patients access to quicker and more appropriate consultations.
  • Winchcombe Medical Centre has 6 GPs and over 7,000 patients.
  • Redesigning the repeat prescriptions process has:
    • released over 150 hours of admin time a year*
    • released over 18 GP hours a year**, offset by clinical workload
    • improved audit trail for both the patient and practice and reduced the risk of errors within the process
    • improved communication across the practice through better working and a more efficient process.

* Time saving based on just over 4 hours released per month across 3 whole time equivalent members of admin staff
** Time saving based on 2 hours per month across all GPs on moving to Batch Prescriptions

As a final part of the three level programme, Learning in Action, cluster level training, based on the ten High Impact Actions, is planned for Autumn 2018 onwards.

Implementation tips

  • Let practices choose the improvements they want to make; they are experiencing the day to day issues and will highlight which problems need fixing the most.
  • Encourage collaboration and networking, this will help deliver improvements quicker across the locality and give teams ongoing access to peer to peer support.
  • Quality improvement is not a one-off initiative, it should be embedded into the way practices work and continue to make future improvements.
  • Design a whole programme approach, instead of using individual quality improvement initiatives in isolation.

The programmes are different to anything I have done before, they have given me the time to take stock and do something about the challenges I used to face daily in the practice.  I feel like I now have my ‘manager’s stethoscope’ that includes valuable quality improvement tools and approaches that can make positive changes to the way we work.”

Jacquie Williams, GP, Chipping Campden surgery

If you would like to find out more about participating in the Time for Care programme visit our web page on how to get started.