Delivering quality in challenging times

Gillian Leng, Deputy Chief Executive, NICE

Quality improvement in healthcare has evolved enormously since I began training as a doctor in the 1980’s.  The focus then was on clinical audits, which did seem to make a significant impact on the quality of care for my patients. I spent a year of my training in primary care, where we had no computers and I don’t remember any guidelines being available - if I needed advice, I referred to a text book or asked a colleague. Today, the psychology of behaviour change and the research evidence that underpins how we make quality improvements have both developed significantly. The approaches used across the NHS to drive up quality improvement have also become much more systematic. This shift has brought with it great benefits to patients and the health and social care system as a whole. We now have access to a wealth of advice, guidance, tools and resources to support us to continuously improve the care we give to patients. But as demand increases and resources become tighter, it is a challenge to incorporate quality improvement into our day-to-day roles.  We therefore need to be sure that we are making real progress.

Helping clinicians to make better decisions about the care of their patients is at the very heart of NICE’s role. Most GPs are familiar with our guidelines, but it can be challenging to identify the most important areas for improvement, and to track ongoing progress.  The introduction of NICE quality standards in 2010 helped to provide this focus. NICE standards are specifically designed to help professionals measure progress, enabling them to feel confident that the care they are delivering is always in line with the best available evidence of what works. They sit alongside and complement our national guidelines, and break down the key priority areas for quality improvement into 4-5 key areas. Our standards cover a wide range of health and care topics ranging from multimorbidity (due to publish June 2017) to fever in under 5s and are increasingly popular with primary care colleagues.

On the NICE website we have a collection of good practice examples from GPs who are using our quality standards to drive forward quality improvement in their own practices. Some organisations are also using NICE standards to develop new improvement strategies across entire localities. One example that really stands out for me is the Cheshire & Merseyside Public Health Collaborative (Champs), which is leading a 5-year cross sector strategy to tackle high blood pressure called Saving lives: reducing the pressure. The strategy, which launched last year, focuses on the prevention, detection and management of hypertension, using the NICE quality standard for hypertension. Five ‘beacon practices’ are participating in the work, with their performance being benchmarked against the key areas of care highlighted in the quality standard. The data gathered is being reported at practice level through electronic data extraction using NICE indicators, and this data is being shared amongst the participating practices to allow peer review and informal benchmarking. A performance dashboard has also been developed to measure the progress of each beacon practice against the overall strategy. Less than a year into the strategy and the pilot is already generating interest from other GP practices. Several CCGs are exploring - and some are already starting to implement - their own localised version on the beacon practice and performance dashboard.

At NICE, we continue to work on new and innovative ways to support GPs with quality improvement. Linking in with the Champ strategy, we are currently developing an indicator support package to enable localities across England to measure their performance against our hypertension quality standard. This package will include the technical specification of indicators including the read codes and business rules. We have also developed a new quality statement finder to support our full range of quality standards. This gives you access to every quality statement within all of our quality standards. You can then filter this list by setting (primary care), age, condition and disease to produce your own unique list of priorities, relevant to your surgery and your patients.

Quality improvement has always been an essential part of every GP practice, but large volumes of information, coupled with new and increasing pressures on primary care, has made its achievement more challenging than ever before. NICE quality standards are helping to ease the burden on GPs – from helping them to prioritise what improvements need to be made for their local population through to measuring the results of the work they have done. If you haven’t already, I hope you will take a look at our menu of over 150 quality standards and use them, with your general practice team, to support quality improvement in your surgery and further afield.

Get involved

GPs are absolutely essential to ensuring our standards work for the people putting them into practice. As well as providing wide-ranging expertise, they ensure that the standards we set don’t result in an unsustainable impact on primary care. If you would like to help to develop and inform NICE quality standards, there are a number of ways you can get involved:

  • Tell us your key priorities: Help us understand the areas with the greatest potential to improve the quality of care. 
  • Comment on a draft quality standard: Your opportunity to contribute to the development of a quality standard. 
  • Support a quality standard: Apply to become a supporting organisation for a standard that's being developed.
  • Join a committee: Be part of the group that develops the standards: the Quality Standards Advisory Committee (QSAC).

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