Quality Improvement In Action: Primary Care Networks

As part of Safer Salford, the Safer General Practice work stream was launched in 2019.  This sought to embed the use of improvement methodologies to support delivery of locally driven safety goals, such as reducing wait times, developing population health solutions and reducing harmful prescriptions. Alongside this, the work aimed to support practices to achieve the 2019/20 Salford Standard and support delivery of core elements of the NHS Long Term Plan and the 2019/20 GP contract.

All five of Salford’s Primary Care Networks (PCN) were involved, each with an improvement lead from one of the local GP practices who was equipped and enthused to test and deliver change, working within their Primary Care Network footprints.  Each PCN developed a shared improvement project with an individual improvement aim for each practice.

Improvement aims

Broughton: to reduce wait times for routine appointments

Eccles and Irlam: to reduce incidence of high blood glucose (Hba1C) for patients with diabetes

Ordsall and Claremont: to increase uptake of cytology / cervical smears

Swinton: to improve attendance for childhood asthma reviews

Walkden and Little Hulton: to reduce daily intake of morphine equivalent medications for patients on high prescriptions

What we did

Working with partners, we aimed to facilitate delivery of targeted improvements whilst establishing lasting capability within primary care through the design and delivery of a bespoke training package to the PCN’s support GP practices with their improvement plans. Sessions were designed to provide the space and time to share and explore QI tools to develop, implement and sustain improvements in practices.

This package included improvement planning sessions and two leading for improvement sessions for each of the PCN’s. These sessions aimed to develop QI capability and running of projects, and included content around goal setting, measurement for improvement, testing changes and capturing learning. Alongside this, monthly facilitated calls were organised with neighbourhood leads to provide on-going learning and support with their improvement plans. Improvement support and guidance was also provided for the preparation and provision of materials to support improvement in primary care and neighbourhood working.

Positive Outcomes

By sharing data, knowledge and best practice around how systems and processes work between different teams, we supported and encouraged GPs via the PCN footprint to think creatively and identify new ways to improve safety and best support their local communities and patients.

Despite the project being paused due to COVID-19, there have been a number of positive learning’s and improvements highlighted and being implemented by practices within the different PCN footprints.

At a system level those involved in the project highlighted the benefits gained from working together across the system. The approach of using PCN’s as a vehicle for improvement was the first of its kind. This demonstrated positives including stronger relationships being developed and peer support being received alongside stimulating healthy competition…

“Developing and working as a team across the network sharing ideas and resources.”

“Strong neighbourhood connections”

Working together has enabled the development of relationships, networks and support across the neighbourhoods, and has driven engagement and interest from those who previously may not have engaged. One team has now established a neighbourhood/network patient participation group, which has been set up as a result of the learning from the QI approach used throughout the project.

“Seeing improvements in patients who didn’t previously engage”

“Being able to give other team members exposure and involvement in QI and thus [engaging a] different perspective”

The work was described as an enabler.

“……. for things such as Footfall introduced online e-mail system for consultation- improving access”

[The programme] enabled “PCN discussions around digital solutions”

Communication and engagement has been recognised by the practices as key to building relationships and involving patients in the improvement project to achieve outcomes.

At an individual project level, improvements were beginning to be seen using quantitative data points and measurement for improvement.  A number of examples were also seen beyond data on a chart. For example;

• ‘Mr A’ had 110Hba1C with risk of losing a leg. He had been a patient for a while but had low engagement with the GP practice. Over 10-11 months, his blood glucose level came down to 46Hba1C. Mr A felt that the support network developed whilst being involved in the project, being able to listen to others and understanding what he should/shouldn’t be eating, contributed to a positive change in his long term diabetic condition.
• Of the six patients targeted who had high dosage opioid use, only one did not meet the target to reduce to under 120mg opioid.

Next steps

This work has highlighted some potentially exciting improvements. There are now real opportunities across the Salford system to further develop and build on the improvement foundations already achieved, and sustain innovations and improvements in delivery developed during COVID-19.

As we move forward into 2021, there may be opportunities to further develop the programme offered in 2019/20 to continue to develop QI capability in a short and snappy way to equip staff with the knowledge and tools to feel confident in reviewing processes and improving processes based on what the information shows. Practices picking back up ‘normal work’ could look at both digital and non-digital processes and best practices developed through the project with a view to further refinement and sharing.