Dr Farzana Hussain is a GP in Newham and quality improvement lead for her federation. She has always had a passion for improving patient care but, like many GPs, finds the process of change difficult. Engaging the rest of the team and making changes that stick are particular challenges.
Dr Hussain joined the General Practice Improvement Leaders’ programme (GPIL) in September 2016. Over the course of three, two-day residential workshops, she and the cohort of 30 clinicians, managers, nurses and primary care support staff were coached in facilitating teams to use improvement techniques in general practice. They supported each other through making changes in their own practice during the programme.
For Dr Hussain, the benefits have been immediate. Her only frustration is that she had not learned these improvement techniques sooner. ‘I’ve been a GP for 15 years … once I had done the course I thought, why have I never heard of this, or why didn’t I hear about it earlier?’
Improving repeat prescribing
The Dr Hussain’s practice had a problem with the repeat prescribing system. Too many prescriptions were inadvertently being issued more than once. This was felt to be unsafe and was wasting staff time.
Traditionally, Dr Hussain would have decided how to address the problem and told the staff about the changes. As part of GPIL, she instead tried first to engage the staff and use process mapping to understand the current state. ‘Process mapping is something I’ve never heard of,’ she reports. ‘It’s been really useful in looking through our systems, and being able to think about how and why they work or they don’t work.’
The new approach produced important new insights about the repeat prescribing system. ‘We understood each other’s’ roles, we understood what we were doing well. We could actually visually see, and we could understand what we weren’t doing well.’ As a result, a new system was designed with input from the staff.
The practice then implemented the changes using another technique Dr Hussain learned from GPIL, the Plan Do Study Act cycle. This allows for a new way of working to be tested very quickly with minimum disruption, and it empowers teams to rapidly iron out any issues. Dr Hussain was sceptical about this more disciplined approach at first. ‘I thought who’s going to Plan Do Study Act? But it was about an hour at a meeting. It really wasn’t that long.’
This method was also surprising in the impact on the staff. ‘What was really interesting is when we spoke as a team they readily wanted to do it. We started it, they did it, and again is something that stuck. That fear that I had about asking them to do yet more work changed into joy in seeing how much they wanted to do it.’
As a result of this project, the practice now has a standard process for logging and checking key steps in the repeat prescription process. The new process works smoothly because early issues are addressed quickly, and all staff understand and are committed to it, not least because they helped to design and improve it.
Dr Hussain reports that both patients and staff have benefited. ‘It’s saved time now, and it’s safer for the patients … Just going on the course just gave me some of the tools that I needed just to make changes that stick. It’s made me feel a lot more hopeful.’
The impact of the new approaches learned on the GPIL programme has come partly from applying Improvement techniques to addressing a problem and partly from the team-based approach. ‘We got a better collaborative solution that has stuck, that we would never have done had we done it my usual way. That could be why previous ideas just never really stuck. We never used these tools.’
‘For me it’s been life changing. It’s made me go back to feeling young, even though maybe not looking young. When I was 19 I sat at a medical school interview and they said “Why do you want to be a doctor?” I said, “I want to help people, I want to be able to give the dying patients some hope,” and this has brought it back.’
The GPIL programme is available, free of charge, to anyone working in general practice or with a role directly supporting practices to improve their care. It is based around three, two-day residential workshops spread over approximately three to four 3-4 months, with project work and optional additional reading in between.
The programme is run by the primary care improvement faculty at NHS England’s Sustainable Improvement team. The facilitators are experienced clinicians and managers from primary care, together with specialist coaches in improvement and team leadership. No prior experience or training is required to join the programme.
The programme provides a practically focused introduction to key tools and techniques for leading improvement in general practice. The areas covered are:
- Fundamentals of change and improvement. The elements of successful change. Practical tools and techniques for designing and implementing improvements. This includes the evidence for improvement science, using process mapping and Plan Do Study Act cycles in everyday practice, and practical approaches to measurement.
- Human Dimensions of change. How to engage others and work with them to make changes locally. This includes building effective relationships, techniques for, understanding and connecting with your team’s motivation, and avoiding and handling conflict.
- Facilitation skills. Approaches to use when working with groups. Creative tools and techniques to help keep projects moving. This includes, group facilitation techniques, confident presenting and maintaining progress in improvement.
The programme is held in various locations throughout England, with new cohorts being launched every few weeks. More information on the General Practice Improvement Leaders’ programme is available on the NHS England website.