• Led by Dr Neil Houston, GP and National Clinical Lead, Safety Improvement in Primary Care, Healthcare Improvement Scotland.
  • Hosted by Forth Valley Health Board and run by Scottish health boards, NHS Quality Improvement Scotland, NHS Education Scotland, Royal College of General Practitioners Scotland and University of Dundee.
  • Aimed to provide safer, more reliable care for patients with heart failure or who are on high risk drugs.
  • Used the Institute for Healthcare Improvement breakthrough collaborative model. 

Two areas of health cause particularly high levels of ill health and harm to patients: heart failure and adverse reactions to prescription drugs.

This project focused on identifying and reducing harm and providing safer, more reliable care for patients with heart failure or who are on high risk drugs. It did this by developing quality improvement and patient safety skills in primary care teams.

Key findings

The project aimed to improve care and safety systems in three areas: disease-modifying anti-rheumatic drugs; Warfarin; and Left Ventricular Systolic Dysfunction.

Many practices showed significant improvement in these clinical areas, using process measures, however there was variance between practices depending on the level of engagement.

The small size of the first year programme limited the power of the analysis. Buy-in was dependent on strong leadership with a culture of teamwork. However, 94% of key participating staff felt they had achieved an increased understanding of the importance of quality improvement


  • Developing and implementing the programme across a range of organisations with different agendas.
  • Developing tools and approaches in an area where little work had been done before.
  • Recruitment of practices when there were many other conflicting priorities.
  • Capacity at both board and practice level to carry out the work.
  • Difficulty of spreading the programme within practice teams and problems with IT.

Further reading

Learning report

Using clinical communities to improve quality

December 2013
Learning report

This report introduces an approach – the clinical community – to support and secure improvements in...

About this programme


Closing the Gap through Clinical Communities


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