‘I just assumed your computers talked to each other’ is a phrase not infrequently heard in my general practice consulting room. I often explain to patients that I can’t see their hospital records or access clinic letters sent to their previous GP surgery. Given all that technology can do, I don’t think their assumption – that medical records should be ‘joined up’ between service providers – is unreasonable, it’s just currently often incorrect. This is hopefully soon to change.
NHS England are investing in five ‘Local Health and Care Record Exemplars’, each of which will receive up to £7.5 million in funding over the next two years, to enable people’s information to be accessed by their health and care team as they move between different parts of the NHS and social care system. The exemplars will join existing and emerging local efforts such as the Kent Integrated Dataset and the Manchester Datawell. The plan is that Local Health and Care records will eventually be rolled out across the country so that everyone benefits.
While progress to share data across systems and between primary and secondary care is welcome, we can also do more to share data between general practices to help improve the care we deliver.
Sharing best practice
General practice is moving towards working in bigger operational units such as GP federations, super practices and primary care homes, but the vast majority of general practice in this country is still delivered by (relatively) autonomous GP surgeries. With the breadth of services they offer, it seems unlikely that any of them are providing the best possible care in all domains. There’s huge potential to learn from one another. In hospitals, the clinician-led Getting It Right First Time programme seeks to improve clinical quality and efficiency within the NHS by reducing unwarranted variation. In general practice, we don’t have an equivalent, but we do know that unwarranted variation exists. Given that we often work in our own practice ‘bubbles’, if my practice is doing something well, then how can I spread that knowledge? If the practice down the road from mine is doing far better on diabetic control, how might I hear of this and learn from them?
Sharing data between GP surgeries to identify unwarranted variation, and then working with those practices to ensure that best practice is transferred, seems a logical way to improve the care we deliver. In the latest Health Foundation briefing, Sharing to improve, we look at four case studies of groups sharing data between GP practices for the explicit purpose of improving care. The briefing sets out not only what they’ve already done, but also the infrastructure they’ve put into place to ensure that data is turned into knowledge and actioned for improvement. In some cases, this includes using quality improvement coaches, practice facilitators and online platforms to share learning between participating practices. Although it’s relatively early days, the results being achieved are promising.
Overcoming the barriers to sharing data
It’s clear from our work that the barriers to sharing data between practices to enable improvement vary between different types of practice arrangements. One example of this is data sharing agreements. GP providers, who may run multiple practices across a geographical area, don’t require data sharing agreements to make pseudonymised data available between practices. In most other arrangements (in academic groups, for example), data sharing agreements would be required along with attention to building the trust, buy-in and goodwill to get these agreed. With a clear commitment from NHS England to allow a variety of GP organisations to develop, it’s important to consider the implications of this for data-enabled approaches to improvement. How do we ensure that all practices, and therefore all patients, are able to benefit equally?
A huge amount of work underlies the improvement efforts in our case studies, but the principles are logical. There’s variation between individual consulting rooms in general practice, let alone between practices, and a lot of the time the clinicians involved don’t know where that variation is. We want to do our best for patients, and so illuminating where unwarranted variation lies and helping us to do better seems like a win-win. As our case studies show, these improvement efforts can extend to better ways of working, and to improving some of the ‘operational’ aspects of general practice – things like access to appointments and reductions in ‘do not attend’ rates – which matter to doctors and patients alike.
General practice has comparatively well-developed electronic health records, and practices are increasingly collaborating with each other in a variety of ways. As sharing data across organisations becomes the norm in the NHS, it’s my hope that general practice will embrace its potential to improve the care we deliver to patients. The case studies in this briefing are examples of early efforts to do just that.
Rebecca Fisher (@BecksFisher) is a GP and Policy Fellow at the Health Foundation
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