Helping quality improvement take root in general practice

Five years ago, anyone visiting our website would have been hard pressed to find an improvement project that was led by a general practice. Plenty of projects involved general practices, but almost of all of them were designed and driven by teams based in the acute sector or by commissioners.  

In many ways this isn’t that surprising. Even for a large general practice, it can be a real challenge to set aside enough time to write an application, let alone plan and deliver a project. If the project lead, usually a GP or the practice manager, gets pulled away to fire-fight another problem, there’s usually no-one available waiting in the wings to take on the job. Many GPs have also been reluctant to engage with quality improvement (QI) ideas and methods. The fact that most of the literature on quality improvement has come from the acute sector, and uses language and concepts that feel quite remote from the world of general practice hasn’t helped matters.

Signs that QI is beginning to take root in general practice are now emerging. The launch of the Royal College of General Practitioners’ Quality Improvement Programme in 2013 has certainly helped to raise its profile. A range of practical QI guides aimed at GPs and other primary care professionals is also now available. One of them, published by the RCGP, has been written by our Generation Q fellow, Joanna Bircher, and Q member, Bill Taylor. Another has been co-authored by Niro Siriwardena, who has been involved in numerous Health Foundation improvement projects, the most recent of which, ‘PINCER’, focuses on prescribing safety in general practice in the East Midlands.

The value of QI as a means of helping general practice to deal with the pressures of rising demand, increasing complexity, an ageing population and finite resources has also been recognised at national level. NHS England’s recently published General Practice Forward View lists the development of QI expertise as one of ‘ten high impact actions’ that can help to release more capacity in general practice.

In Scotland, meanwhile, the Patient Safety Programme in Primary Care has developed a range of safety improvement projects and resources for practices, some of which have been supported by the Health Foundation. You can find out more about this work in an interview with Neil Houston a national clinical lead for safety in primary care, who led a Health Foundation-funded safety collaborative within general practice. A case study on another Scottish primary care safety project, this time led by NHS Education for Scotland, is also included this month.

The growing volume and quality of applications to the Health Foundation’s innovation programme from general practice shows an increased appetite at practice level for QI. This newsletter includes a Q&A with Ollie Hart, a GP in Sheffield who oversaw the first practice-led innovation project we funded, which sought to enable people to self-manage musculo-skeletal pain. Another practice-led project, which is looking to address gaps in the care pathway for people with dementia in Sussex, is also featured in this edition. But they are not the only ones. Among the other projects we’re supporting is one led by the Valentine Health Partnership in Woolwich, which is developing data analysis methods to identify patient population segments with similar care needs and then design interventions tailored to those needs. Cowgill Medical Practice in Bradford, meanwhile, is developing an online questionnaire for patients with suspected upper gastrointestinal malignancy so that they can be referred promptly for appropriate investigations.

Welcome though all of this is, we shouldn’t get too carried away just yet. There are still lot of practices that have had no experience of designing and implementing an improvement project. Many of them would find it hard to find the time to do it, or to build up the skills they need. Data collection and analysis skills are particularly in short supply.

The trend towards greater collaboration between practices, either through formal partnerships and federations or looser networks, could help to address this deficit by enabling economies of scale and the development of greater in-house technical expertise.

It will take time and no little resource to build up this improvement capability, together with consistent support at national level. But the mounting interest in improvement among practices - certainly if the level of applications to our programmes is anything to go by - does provide real grounds for optimism.

Bryan Jones is an Improvement Fellow at the Health Foundation