Stories of outstanding impact in primary care

While GPs remain at the heart of the health system in the UK, they are coming under increasing strain. An ageing population, more people living with long-term conditions, patients reporting dissatisfaction with services, and persistent variation in quality of primary care are just some of the problems they are facing.

The improvement projects we’ve funded in primary care show how services are responding to these challenges: working in partnership with patients and other areas of the health system; treating people in the community in more cost-effective ways; and finding new models of care that promote self-care, shared decision-making, and better communication.

Two of our projects, both originally part of our Engaging with Quality in Primary Care programme, have had a particularly strong and lasting impact, changing working practices in primary care both nationally and internationally.

1. REST – resource for effective sleep treatment

REST, an innovative sleep treatment project that began in 2009, has gone on to make a remarkable national and international impact, its findings even being cited by the North American Space Agency (NASA).

Starting out as an improvement collaborative involving 16 GP practices in Lincolnshire, REST aimed to discourage GPs from prescribing sleeping pills as a first line response to people experiencing insomnia, and to encourage them to explore other options that may better suit patients’ needs. The project team worked with patients to understand what they need from a consultation for insomnia and tested the impact of different approaches.

Findings, which included improvements in patients’ experiences of care, and significant reductions in prescribing sleeping pills in some practices, went on to be shared at a UK-wide event in 2011 run by the Royal Society of Medicine. Later that year, the findings were broadcast in an ITV documentary.

Since then, the success of REST has led to national changes in health service policy and practice, with findings incorporated in guidance to clinicians developed by the National Prescribing Centre.

REST has also made a considerable international impact through a series of workshops, seminars and e-learning resources, resulting in changed behaviour among GPs, nurses and practice teams, and changed relationships with patients. Clinicians have moved away from prescribing drugs to using psychological therapies for insomnia – a cultural shift towards shared care and greater patient involvement.

Read more about REST

2. IRIS – improving the primary care response to domestic violence

IRIS, originally a trial training and support programme, has been highly influential in the treatment of domestic violence cases, having an impact on both national and international policy.

IRIS was led by Queen Mary, University of London. Involving 48 GP practices in Bristol and Hackney, IRIS focused on how primary care can better respond to domestic violence. A programme of resources was specially designed to help GPs identify patients experiencing domestic violence, and make referrals to a specialist agency providing advocacy.

Initial findings included an increase in the identification of people who have experienced domestic violence and referral to specialist services, as well as a reduction in recurrent abuse and improved quality of life.

Following its success, the programme has been commissioned by CCGs and local authorities in 12 areas of England, with training delivered to 122 general practices. IRIS also began implementation in Scotland in 2013.

IRIS findings and implementation have been included in draft NICE guidelines, the 2012 Welsh Assembly Government White Paper, and the recommendations of Home Office Domestic Homicide Reviews.

The landmark 2013 World Health Organisation publication ‘Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines’ drew heavily on IRIS research, citing the IRIS model.

Read more about IRIS