Case study summary
Newham CCG has an ambition to build on the quality improvement capability and capacity that exists across its 51 practices. To help its workforce develop the skills and confidence to lead change, it invited practices to participate in the Learning in Action programme. The programme is delivered by NHS England’s Sustainable Improvement team and part of the support available through the General Practice Forward View.
Work collaboratively to tackle local issues around inefficient processes to develop better and more efficient processes.
Identifying the problems
The Sustainable Improvement team’s development adviser worked closely with UCLPartners (an Academic Health Science network), to design and tailor a local improvement programme. UCLPartners had already been commissioned by the CCG to work locally, and they facilitated close engagement with the practices to identify their local needs through a series of semi structured telephone interviews, followed by a practice visit to each of the 17 practices that expressed an interest in the programme. Areas such as document workflow and prescribing processes came out as high priorities practices wanted to improve.
The outcomes from this engagement process then enabled the Sustainable Improvement team to tailor and develop a local Learning in Action programme, to address those needs and engender a learning environment where collaborative working was embraced.
Over six months, representatives from each practice including GPs, practice managers, a pharmacist and administration staff, attended six workshops where they worked together to roll out projects within their practices. The group started by discussing what issues they were experiencing within their practices and found that a number of problems were common to most of them, where others were more specific to individual practices e.g. clinical staff spending too much time on document management was something many could relate to, whereas receiving discharge summaries without medicine reconciliation was a more specific issue for others.
Recognising they were not alone and were all experiencing issues, sparked an enthusiasm and motivation amongst the group to reach out and support each other.
Practices sharing their experiences and ideas
Whilst all were experiencing problems there was also a lot of good work taking place that the group shared with each other, as well as experiences teams might find useful when rolling out their projects. This helped individuals identify the priority areas they wanted to take back to their teams to work on, with the knowledge that they were equipped with tried and tested ideas that were already being successfully used elsewhere in Newham.
A safe environment to support and challenge
During the workshops that followed each practice was given an opportunity to share their learning and how their project was progressing. The teaching and leadership style of the Sustainable Improvement team’s facilitators, helped create a welcoming environment that gave everyone a chance to get objective feedback from their peers safely and in a supportive way, without fear of challenging one another. For example, one team was struggling to become paper-light because a partner preferred paper-based documents. When the group challenged the partner that this was not the norm they recognised they had become ‘stuck in their ways’. This encouraged them to work closely with UCLPartners’ quality improvement lead to explore different online platforms they could use to reduce paper-based correspondence in their practice.
In between workshops the group was able to continue communicating remotely via a WhatsApp group facilitated by UCL Partners. This helped the practices to keep the momentum of their projects going and access neutral support outside the face to face workshops. This was also fed-back into the design of future workshops.
Developing the skills and knowledge to lead change
The group was introduced to a number of quality improvement tools and techniques. Some in the group had come across similar tools before, reintroduction of these tools reinforced their confidence in their knowledge and application of them. For others it was new learning and introduced a new vehicle to help drive change towards much wanted improvement.
In one practice the senior partner and receptionist driving forward the project had no prior knowledge of quality improvement and were struggling to get their project moving. Learning about the different tools helped them recognise their project was too big for their colleagues to grasp. They changed this by creating a smaller and more focussed project, and found that using a process mapping exercise enabled involvement from more colleagues and helped to break down some of the barriers by improving engagement. They expressed the benefit of having a practice visit which allowed for some face to face external facilitation. During this visit they were able to troubleshoot some issues around data gathering as it helped to also reinforce some of the classroom learning.
Close partnership working between the Sustainable Improvement team and UCLPartners, has led to the CCG being able to strengthen the quality improvement capability and capacity of its workforce, giving staff the skills and confidence to work more efficiently and improve the sustainability of their practices. Improved cohesive working and collaboration between practices has led to the impact below.
Star Lane Medical Centre has:
- reduced the number of documents going to its GPs by 62%
- implemented a new system for document workflow
- provided staff with opportunities to learn new skills – staff enjoyed coming together and learning from each other.
Vicarage Lane focused on ensuring 100% of all discharge summaries sent to the practice included medicine reconciliation resulting in:
- raised awareness of the importance of accurate medicine reconciliation
- releasing 7.5 hours of medical secretaries time per week
- improving quality and safety via a new pharmacist-led process.
Glen Road Medical Centre improved the delegation of admin work which has:
- reduced the number of letters seen by a GP by 65%, as a result GP workload has reduced and they are going home on time
- removed the need for a GP to carry heavy bags of documents home to sort/review in personal time, both having a positive effect on physical health and better work life balance
- reviewed practice processes and made document handling more streamlined by training and upskilling a non clinical member of staff to undertake the scanning, sorting and distribution of documents, rather than depending on the GP to do all of this
- allowed for a more timely response to necessary actions leading to better patient care.
Wordsworth Health Centre reduced the number of paper-based documents sent to GPs which led to:
- redesigning more efficient processes that have released 2.5 hours of GP time per week
- developing staff skills that have expanded their knowledge base
- greater staff satisfaction as a result of the improvements made.
The programme has been a platform for many of us embarking on a lifetime of quality improvement projects. The journey has been very special to take part alongside colleagues from Newham, including clinical and non-clinical staff who were willing to share their projects with the whole group. Networking and collaborating with like-minded colleagues to share ideas and tips has been the highlight of the programme.
Dr B Sathyajith, GP, The Shrewsbury Centre
At individual level we have seen lots of personal growth, staff have not only learnt about quality improvement, but we’ve also seen confidence and facilitation skills grow across the workforce.
Dr Zenobia Sheikh, GP Quality Improvement Lead, UCLPartners
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.