“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.”
Professor Martin Marshall, UCLPartners Primary Care Development Programme Director
Newham 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 skills that would enable the sustainable delivery of high quality and efficient primary care services.
Challenge/ problem identified
There are 53 practices in Newham that treat a population of over 300,000 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, many primary care staff lack the experience and practical skills to ensure this performance is sustainable.
Quality Improvement (QI) in health care is a technique used to test new models of care, changing practice to streamline processes, use resources more efficiently and deliver high quality patient care on an ongoing basis. With demand on General Practices increasing, equipping staff with these QI skills is essential. Therefore, UCLPartners has been working with Newham Clinical Commissioning Group (CCG) to support General Practice staff in the borough to develop these important skills.
General Practice staff in Newham were invited to take part in a QI collaborative. QI collaboratives are a way of carrying out rapid improvement programmes at scale and pace and involving multiple partners.
Nine General Practices participated in the collaborative. In each practice, multi-professional teams, including service users, came together to work on a system in their practices where there was perceived to be room for improvement. The practices decided to focus on a number of areas all related to the patient safety aspects of unplanned admission; adverse drug reactions, medicines reconciliation, the management of high risk medications and managing laboratory results.
Over the course of a year, the project lead for each practice attended six learning sessions and a concluding summit event. In between each session, improvement teams exchanged ideas, presented findings and learned QI methods including Plan, Do, Study, Act (PDSA) rapid improvement cycles to collect data and to test and apply changes.
In total 356 primary care staff were trained to use QI methodology and a number of QI champions were created in the area, with the ability to spread and embed the use of these techniques on an ongoing basis.
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.
“Taking part in the collaborative was a fun journey that taught me how to work in new and innovative ways.”
Gupinder Syan, Senior Primary Care Pharmacist and collaborative participant
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
The Academy was launched in April 2017.
Which national clinical or policy priorities does this example address?
- Care and quality gap
- funding and efficiency gap
Contact for help and advice
Project contact for further information:
Rachel Penniston, Head of Quality and Capability Development Programmes, UCLPartners
Media contact for further information
Frances Sheridan, Communications and Engagement Manager, UCLPartners