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As a practising GP I see first-hand some of the factors that can make quality improvement in general practice a challenge. Analysis of over 100 million consultations in England between 2007–14 showed an overall increase in GP workload of 16%. The scale of that increase hasn’t been matched by proportionate increases in funding or workforce, and GP morale is low. It’s easy to see that for many GPs, spending considerable time on improvement work is simply not possible, even if it is desirable. One way that general practices might make more effective and time-efficient progress on improvement efforts, despite the pressures they’re facing, is through harnessing one of the great assets of primary care in the NHS: its uniquely well-developed data infrastructure.

As part of my year as a National Medical Director’s Clinical Fellow at the Health Foundation I have been undertaking research, to be presented at the upcoming International Society for Quality in Health Care (ISQua) conference, looking at the potential for data sharing across GP practices to drive improvements in patient care.

We used five case studies of groups already working in this area, and aim to share learning from their experiences. Although each group had a distinct way of working, there was a common premise; if groups of practices collaborate to pool data centrally, analyse and compare it, and then share learning across the network, can we improve care across all participating practices?

Harnessing the potential of data for improvement

The Clinical Effectiveness Group (CEG) in East London, one of the case studies featured in our research (and forthcoming report), is increasingly known both for its novel approach to improvement, and for the dramatic results it has achieved.

Working in some of the most deprived boroughs in the country, practices across five clinical commissioning groups (CCGs) have been supported by the CEG to share their data in locality groups. They’ve benefitted from analytical support and practice facilitators to turn that data into information, knowledge and action to implement change.

The practical measures that were put in place because of the sharing of data led to clear benefits to local patients, and performance against a variety of indicators, including blood pressure and diabetes control, is now among the best in the country. The CEG is harnessing the potential of data to improve performance and reduce variation in general practice.

What lessons could we learn from them and others to share more widely?

Data sharing is just part of the picture

In the case of the CEG, and looking across the other case studies in my research, some themes are emerging. The first is that while data, and in this case data sharing, is central to these improvement efforts, it is necessary but not sufficient. Showing practices their data, particularly in comparison with others’, often acts as an eye opener and highlights priority areas for improvement. In doing so it provides foundations for change, but converting that data into action requires additional support.

Across our case studies there is no one size fits all approach to this support, but all the groups do carefully consider how best to help practices implement change. For some this involves convening regular clinical improvement meetings (at which comparative data is discussed, and learning and ideas shared). Other groups employ quality improvement coaches, or facilitators to work alongside practices and support improvement efforts.

Though sharing data across practices may not sound revolutionary, for some GPs having their practice data directly compared with others’ will require trust and create a degree of vulnerability. Avoiding perceptions of performance management is key, and data needs to be used with and by practices, not for and to them.

Widespread use of electronic patient records in general practice makes it fertile ground for data sharing approaches to improvement. Even this though is nuanced, and the ease with which data can be shared will depend not only on how easily different electronic patient records can ‘talk’ to each other, but on adherence to the information governance requirements necessary to share pseudonymised patient information outside of individual practices. None of these are insurmountable barriers to this approach; they just require careful consideration, and attention to cultural and operational aspects of data sharing.

Like all of my clinical colleagues, I want to deliver the best possible care for my patients. As a GP with an interest in improvement, the question I’m asking myself now isn’t whether we should share data across primary care providers for improvement; it is how we can best do that.

Rebecca Fisher (@BecksFisher) is a Clinical Fellow at the Health Foundation

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