11 May 2017

Embedding a culture of quality improvement in General Practice in Newham

GP and patientNewham is amongst the most deprived boroughs in the country. The area also has one of the most mobile populations with a unique set of health needs, creating substantial challenges for General Practice.

Between January 2015 and December 2016 UCLPartners worked in Partnership with Newham Clinical Commissioning Group to support General Practice staff in the area to develop important Quality Improvement skills to enable the sustainable delivery of high quality and efficient primary care services.

The challenge
There are 59 practices in Newham that treat a population of over 308,000 patients. Whilst the population number in the area is expected to increase with an annual growth of 20%, the number of practices are slowly declining.

  • Newham is amongst the most deprived boroughs in the country, and has:
  • The highest birth rate in England
  • The highest TB rate in England
  • The second worst cancer 1-year survival
  • One of the highest rates Type 2 Diabetes Mellitus in England
  • High HIV prevalence; but 26% undiagnosed
  • High smoking rates and ¾ adults report VERY low physical activity levels

GPs in the area perform consistently well against many enhanced services and public health targets. However, although the borough achieves excellent quality and outcome scores, it lacks experience and practical skills in using Quality Improvement (QI) techniques.

With demand on General Practices increasing, equipping staff with QI skills is essential to enable practices to streamline processes, use resources efficiently and deliver high quality patient care on an ongoing basis. Therefore, UCLPartners has been working with Newham Clinical Commissioning Group (CCG) to support General Practice staff in the borough to develop these important skills.

Taking action
General Practice staff in Newham were invited to take part in a QI collaborative. Nine General Practices in Newham participated in this improvement collaborative. Practices were guided and supported to run improvement projects based on the Institute for Healthcare Improvement’s Breakthrough Series Collaborative Model and using ‘Plan- Do- Study- Act’ (PSDA) learning cycles. All practices ran projects which focussed on key patient safety practices such as medicines reconciliation, management of high risk medications and unplanned admissions.

Staff from the nine practices were invited to six learning sessions which ran every six weeks. At these sessions staff learnt QI theory and methods and were presented with real life examples of changes already being made in General Practice using the Model for Improvement.  Between learning sets, teams were able to test their own change ideas within their surgeries, then reflect, learn and refine these tests. In-between learning sets practices were supported by a dedicated QI lead who was available to provide advice and guidance on specific improvement projects.

Seeing results
Bundles of four to five evidence-based clinical care indicators were used to assess teams’ compliance with optimal standards of safe and reliable care. Data showed that as a result of improvement projects that took place:

  • Three practices tripled their compliance to optimal medicines reconciliation standards, meaning that time between hospital discharge and GP medication changes was reduced.
  • Three practices doubled their compliance to optimal results handling practices, meaning patients were informed of pathology results earlier and more reliably.

In addition, patients reported improved experiences and administrators found they had more time. All practices that took part in the collaborative reported increased confidence levels in designing and running small improvement cycles, something they felt could be applied to run effective improvement projects independently in the future.

Senior Primary Care Pharmacist and collaborative participant, Gupinder Syan, said: “Taking part in the collaborative was a fun journey that taught me how to work in new and innovative ways.”

Plans for the future
The success of this work has paved the way for a new Quality Improvement Academy in Newham, offering a range of opportunities for primary care staff in the borough to develop skills in Quality Improvement. Opportunities on offer include:

  • A bespoke fundamentals of QI course delivered by NHS England, specifically tailored for Newham
  • A second collaborative for General Practices in Newham delivered by NHS England, focussing on the 10 High Impact Actions to release time for care
  • A QI network for existing and emerging primary care leaders in the borough, providing the opportunity to share experiences with peers and learn from experts in the field of QI
  • A portal of resource sharing best practice in QI

Reflecting on the success of the project, UCLPartners Primary Care Development Programme Director, Professor Martin Marshall said: “General Practice staff in Newham have shown a great appetite for developing QI skills. The improvement projects that took place as part of the collaborative are strong examples of how even small changes can make a big difference to both patient care and staff experience. As a result of these positive changes we have launched a Quality Improvement Academy that will offer primary care staff from a range of disciplines the opportunity to develop these important skills, equipping them with the tools they need to continue to deliver a high quality and efficient health care service in this demanding borough”

The Academy was launched in April 2017.