The idea

The federation already had an integrated care model and was in the early stages of developing better system working.  Working with its local alliance it had applied for Primary Care Home whilst participating in the Learning in Action collaborative element of the Time for Care programme.

An opportunity arose to utilise the quality improvement tools and techniques within the Learning in Action programme, and move from a focus just on groups of general practice staff in the area to also include frontline teams across health, social care and communities. The intention was to support implementation of Primary Care Home by working with a wider range of providers on ‘how’ they could build partnerships and develop new ways of working.

The federation and its alliance partners saw that by combining the two programmes, there was an opportunity to support its implementation plans for the General Practice Forward View at scale across all four of the county localities (using the recommended 30-50K population for each locality as a guide).  This would allow member practices to look at their priorities in a more rounded and collective way, whilst at the same time work with other health and social care professionals, whose support and collaboration they needed to truly redesign primary care at scale across Hereford.

What happened?

Building relationships with key stakeholders

Prior to the development programme taking place, the federation invested time and effort into engaging with key stakeholders to bring them on board. This required strong leadership from the federation, who had built up trust and relationships with many stakeholders over the years. Stakeholder engagement was crucial to the programme’s success and this was clearly demonstrated when 70 participants attended a collaborative workshop on social prescribing. Delegates included commissioners (CCG and council), district nurses, therapists, mental health and voluntary staff, social care coordinators, practice managers and the federation and alliance management teams.

Quality improvement and collaboration at scale

A series of workshops were held, bringing together, for the first time, a wide range of health, social care and voluntary sector professionals, to work collaboratively with practice teams on the redesign of primary care.

At the first workshop time was spent helping teams understand the national and local context. This was important so all were clear on the purpose and aims of the work, along with the benefits it could deliver for patients and staff.

Frontline teams moved on to use their local population health data to identify projects they wanted to work on across each Primary Home Care locality. Social prescribing was chosen across the localities as the first project.

As teams worked through their projects they were introduced to a number of quality improvement tools and techniques by the Time for Care team. These included the Change Model, process mapping and tools for identifying opportunities for improvement and generating, prioritising and testing ideas.

During the workshops teams updated where they were with their projects, sharing what was currently working well, and learning from others whether there were any ideas and experiences they could adopt.  Practices were keen to help each other, which started to develop and strengthen a culture around sharing and learning.

Quality improvement has practically assisted participants to progress their projects, redesign ways of working (including working at scale) and measure any impact of the changes. Fundamentally, the environment of collaborative learning strengthened local focus on building relationships and ensuring local teams could practically apply quality improvement to redesign primary care successfully and sustainably.

Impact

• Collaborative working between general practice and health and care teams has been hugely beneficial. Bringing both groups together for the first time to redesign primary care in its widest sense, has made improvements at a greater pace across the whole locality, which previously would have not been possible.  Change is now happening at scale.
• Social prescribers have been employed to be shared between localities. During the first six months they have received 524 referrals from across the practices which previously would have resulted in inappropriate GP appointments.
• Social prescribing pathways are being examined to combine existing council and health personnel and develop working relationships with general practice teams across localities.
• GPs are being able to better manage their workload as they are able to refer patients for non-medical problems more appropriately and focus increasingly on their core role. GPs have feedback that those patients they have referred to other more appropriate services have not felt the need to return to them.
• Patients’ needs will be considered in a more holistic way, as a whole person and not just the individual problem that is being presented, resulting in them receiving a more seamless and timely service across both health and social care. In some cases it is preventing social problems from becoming medicalised.

Implementation tips

• Take time to educate teams and help them understand the programme of work they are entering – do not take it for granted they will already know.
• Ensure teams own the programme and the areas they want to improve otherwise it will not succeed.
• You do not need an alliance to do this. Just work with the people you interact with all the time, whoever they work for. Go with the energy!
• Use the benefits of Primary Care Networks and the learning from initiatives such as the Primary Care Home model to centre on the development of relationships and ‘bottom-up’ approach.

“Learning in Action and Primary Care Home are a natural fit, bringing the two together made perfect sense to us.  It has enabled us to take different elements of the General Practice Forward View and make changes at scale a reality.  The programme will carry on well into the future, helping us to continuously make improvements and redesign our primary care provision so it’s fit for the needs of our staff and patients.” Dr Mike Hearne, Medical Director, Taurus Healthcare Ltd

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.