Supporting Quality Improvement

in Primary Care

Clinical Leadership to Improve Health

Primary Care Improvement Plan (PCIP)• Multiple work streams directed toward improving safety

and quality

NHS Improving Quality (NHSIQ)• Leading Improvement of Quality and Safety in Primary

Care (LISQ)

Somerset Quality Practice Scheme (SPQS) • Alternative to QOF

• Motivating primary care to examine and change an established model of practice

Clinical Leadership to Improve Health

LISQ – Launch Event, August 2013• Joint Governing Body and COG development session

Making the case for change• challenging assumptions about safety in primary care• time to think and reflect• enhancing and distributing leadership• Empowering patients

NHS Change Model

Clinical Leadership to Improve Health

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Number of encounters for each fatality

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Driving

Chemical Manufacturing

Chartered Flights

Scheduled Airlines

European Railroads

Nuclear Power

What do we know?

Amalberti, R., Y. Auroy, et al. (2005). Ann Intern Med 142(9): 756-764

NHSChange Model

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Complexity of the environment-incentives-CCG priorities-NHS England-CQC -and more!

Leaders to be a visible presence as COG leaders PPG Involvement Agreement to change – rather than imposition Identify other leaders Federation leadership and support Measure the baseline Identify resources and drivers Safety risks – vulnerable patients who trust their drs! Time to think and reflect

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LISQ Launch Event outputs

14 practices across 6 federations 5 workshop days November 2013 – May 2014 Financial incentives to participate – backfill costs Learning

• the case for change• improvement tools and techniques

Improvement testing back at practices between workshops

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Established greater insights into patient safety issues Less fear about mistakes – look at the system people

are working in A range of tools and techniques to support making

change and improvement A foundation to build networks for sharing and learning

together collaboratively Medication reporting in primary care Skills and competencies are transferable to other

aspects of work

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Build upon the learning• Federation sharing and learning• Access to tools and techniques• identify local issues at federation level for collaborative learning

Medication reporting as a model for sharing and networking

Links to SPQS• increasing primary care adaptive capacity• use the model, tools and techniques for exploring variation• time and space to review systems and processes• enable primary care to rise to the challenges ahead

Clinical Leadership to Improve Health

An initial approach to the Area Team by the LMC and CCG, proposing an alternative approach to QOF

Strong support from the Area Team for innovation

National concern about allowing local variation, especially from the GPC and from some senior leaders in NHS England

Despite the tight timescale, a thorough process of engagement with GPs and other stakeholders

Clinical Leadership to Improve Health

Deep wish to focus on integration, including information sharing

A strong sense that QOF is not facilitating the best quality care (overly medical, insufficiently person-centred)

Strong support for more person-centred care

Education campaigns to influence use of services

Freedom to innovate, but also clarity over what is expected

Clinical Leadership to Improve Health

Not a detailed set of clinical specifications like QOF. Instead GPs commit to three things:

1.Continuing to deliver good quality care

2.Working together with other practices and providers to develop local integration plans

3.Working together with other practices to improve sustainability

Clinical Leadership to Improve Health

Project management support available to practices from the CCG

Funding is based on what practices would have earned from QOF with 70% guaranteed and 30% dependent on satisfactory update reports

South West Academic Health Science Network is leading the evaluation, which focuses on clinical quality and the role of GPs in integrated care systems

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Some examples of innovations undertaken as part of SPQS:

Shared nursing staff across groups of practices

Enhanced end of life care in a very rural community

Voluntary sector clinics in general practice

Person-centred care planning and peer support

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AHSN evaluation due July 2015

Outcome based

• patient activation and experience

• selected QOF measures - CQRS remains active

Measuring and acting on variation

Practice ownership of measurement

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• The relationship between the CCG, LMC and Area Team was crucial.

• There are multiple definitions of quality in general practice.

• The time needed to design an alternative cannot be underestimated.

• The acceptability of measures to clinicians is an important success factor in quality improvement projects.

• Our approach to incentives tends to focus on financial incentives. We found that a strong incentive for general practitioners is a satisfying working day. Consideration of incentives in a broad sense is therefore important.

Clinical Leadership to Improve Health