Quality improvement: not just another task

In general practice we all feel under pressure and are unable to add yet another task to our day. So when an opportunity arises to improve our work a lot just by investing a little, that is a welcome change. That is just what quality improvement (QI) methods and tools offer. These simple tools can help us and should be considered an integral part of the role of a modern doctor.

Investing a little, gaining a lot
The pressures that general practice are under make it essential that any improvements GPs and their teams make are effective, efficient and sustainable: low investment for high returns. QI approaches and tools support us to achieve that. Now general practices are working more in groups of practices, which creates opportunities to share QI knowledge, skills and examples of how it works. New models are being considered for general practice and these would benefit from testing using QI approaches and tools.

Continual improvement
As GPs we have taken great strides in moving the profession forward and delivering the care that patients need and in the way that they need it. In the past, the GP was mainly trained in clinical science and clinical method. In more recent times, training in communication skills has been important in helping us improve patient experience and care, and now training in QI methods is being added to the curriculum for the doctor of today and tomorrow to take yet another step towards even better run practices, great patient experience and better outcomes.

Making progress together
In several areas of the UK trainees are conducting quality improvement projects after basic training in the methodology. Established practitioners also need to be aware of QI methods to support their implementation and improve outcomes for practices and patients alike. The Academy of Medical Royal Colleges are also working together to pool their resources in the field of quality improvement.

A step-change for general practice 
The RCGP’s mission is to enhance patient care by improving general practice. There is an imperative to harness these aims with “evidence-informed”  quality improvement.1 The King’s Fund inquiry into improving the quality of care in general practice recommended that the RCGP should have a wider role in promoting QI. The science of quality improvement is developing: Marshall et al state that “by engaging with the science of improvement, general practice has an opportunity to further build its reputation as a leader in the field of quality improvement”.2 The RCGP can lead general practice in this direction.

Tools from us, examples from you
The RCGP has been at the forefront of promoting two quality improvement tools: clinical audit and significant event analysis (SEA).  It is in the process of widening this to other quality improvement methods. The Clinical Innovation and Research Centre (CIRC) is now making tools and resources relevant to general practice available on its website for you to use.  An RCGP Quality Improvement Framework has been trialled with CIRC clinicians and is now being piloted to improve care of patients with diabetes.

RCGP is keen to collect and share examples of quality improvement carried out in general practice. If you have an example you wish to share please contact sarah.pollet@rcgp.org.uk.

Marshall M, Baker M, Rafi I, Howe A. What can science contribute to quality improvement in general practice? BJGP 2014 64 no. 622 254-256

The King’s Fund Improving the quality of care in general practice. Available at http://www.kingsfund.org.uk/sites/files/kf/improving-quality-of-care-general-practice-independent-inquiry-report-kings-fund-march-2011_0.pdf

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