Quality Improvement (QI) at the RCGP

‘Helping GPs to do the best possible job in an imperfect world through constantly improving professional practice’

Have you seen our new QI webinars menu below? Webinars on the topics of Building Capability and Improving Diabetes Care are scheduled throughout December.

Applications are now open for the 2017 intake of Quality Improvement projects. Full details available here.

What is Quality Improvement?

Quality Improvement is a commitment to continuously improving the quality of healthcare, focusing on the preferences and needs of the people who use services. It encompasses a set of values (which include a commitment to self-reflection, shared learning, the use of theory, partnership working, leadership and an understanding of context); and a set of methods (which include measurement, understanding variation, cyclical change, benchmarking and a set of tools and techniques).

In primary care, we don’t have time or resources to spend on things that don’t work, don’t serve our patients, and that could be done more efficiently or effectively. QI helps us identify what works well and where we can make changes.

The RCGP's Quality Improvement Guide for General Practice is the College's overarching guide giving background and context to all things ‘QI’ in General Practice.

What is in it for me?

QI is an evidence-based approach that helps primary care free up time to deliver and evaluate initiatives, and embed new approaches more effectively and efficiently into practice.

QI helps us to make the most of our systems, organisations, talents and expertise to deliver better outcomes for patients.

This directory is your starting place for all QI resources the College has and is developing. These resources and guidance are developed with members, by members, and for members.

We have developed a framework using these principles which will evolve over time, just as the QI activities members undertake change and increase.

These tools and guidance, and the examples in practice, are for all primary care practice staff.

The College recognises its role in taking the initiative around the quality agenda, and that there is a need to reflect our member’s experiences rather than focussing solely on the gold standard level of quality. ‘What good looks like’ changes over time and we want to encourage all members to engage in QI activities on a broader level of continuous improvement, supporting the whole membership irrespective of where they are on the quality spectrum.

Webinars

Supporting Quality Improvement 

Thursday 9th February 13:00 - 14:00

The RCGP wants to support you to introduce and integrate quality improvement into your practice. We know there is so much we can do to support each other to tackle to challenges we all face in day-to-day practice.

We are building on the success of the guide “Quality improvement for General Practice” with the launch of a new on line learning  and QI support network and a self accreditation process.

This webinar will:

  • Inform you of the resources which will be available on the on line learning network
  • Describe the self accreditation process
  • Discuss how to motivate members of your practice in quality improvement
  • Show how the guide has been developed for easy use.

Discussion of the above will be followed by an interactive question and answer session.

You can register for this session here.

 

Sharing practical experiences of Quality Improvement - 6 December 2016

This webinar explored issues surrounding improving the care you give to your patients in an effective and efficient way. View the presentation here and view a video of the webinar here.

QI Ready

QI Ready is a self approval tool to assist you in better understanding QI methodologies, including clear examples of QI in practice. It also provides a forum and shared learning network to showcase QI projects you or colleagues have undertaken, and to communicate with other GPs and practice staff around their work in this area.

This tool serves to make you more confident and competent in undertaking quality improvement through an online support package and approval process.

Click here for more information and to register your interest in QI Ready

'How To' Bite Sized Learning and Guidance

There are a variety of tools and methodologies that you can pick and choose from to undertake quality improvement activities within your practice. These resources provide a variety of approaches you may wish to take, explaining where and when to apply each and providing clear examples to work from. These resources all derive from the full version of the RCGP's Quality Improvement Guide for General Practice.

Clinical Audit

RCGP is widely involved in audits and in supporting GPs to complete them. This information and guidance will explain more about clinical audits, explore peer reviewing, and act as a gateway into numerous audits the College is involved in.

Significant Event Audit

Significant event audit forms part of practice and individual learning. These resources aim to assist you in practice and individual learning, with guidance and examples to better understand the process.

“How to” Bite Sized Learning - 'Plan-Do-Study-Act' (PDSA) Approach

A practical guide on identifying smarter ways of working. The approach allows change to be introduced in a considered way but on a small and manageable scale, measuring the ‘before’ and ‘after’ effects of each change, and provides evidence to assist in maintaining the changes that work.

“How to” Bite Sized Learning - Data Sources

Links to data useful in undertaking quality improvement. The type of data available from each sources is described. The list is organised by UK nation. This area is constantly changing and this will be updated regularly.

“How to” Bite Sized Learning - Run Charts

A tool that allows practices to analyse data, with minimum use of statistical methods, and helps determine if an improvement has been made.

“How to” Bite Sized Learning - Process Mapping

A visual tool that assists teams to analyse and streamline processes, freeing up valuable time for other activities.

Examples in Practice - Clinical Area Specific

This is a growing list of QI approaches being piloted or fully delivered in practice. Most have a clinical area specific approach, and we could encourage you to either reproduce these themes within your practice and  apply the methodologies to other clinical areas of interest.

• QI in Patient Safety

Funded by the All Wales Therapeutics and Toxicology Centre, PRIME Centre Wales, and NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, the QI in Patient Safety project is party of the Clinical Priority Programme at the RCGP. It will specifically produce a ‘how to’ guide with examples of using quality improvement methods in primary care, using the learning from patient safety data to plan and undertake improvement projects in practice. This will include expanded excerpts from published research where QI tools have been used to present findings from over 50,000 safety reports.

• Cancer SEA pilot

Working in partnership with both NHS England and Macmillan Cancer Support, the Quality Improvement in Early Diagnosis of Cancer pilot focused on the use of Cancer Significant Event Analysis (SEA) as a QI tool to improve patient outcomes. The pilot generated findings and created tools to support action at the frontline including an improved Cancer SEA template, online toolkit for CCGs and learning providers, and a GP guide for primary care.

• Diabetes in Wales

Working with the All Wales Diabetes Implementation Group, this pilot programme aims to build capacity of general practice in Wales to undertake quality improvement in diabetes care. This will result in a review of the RCGP curriculum, cascading learning, generating case studies, and developing toolkits for GPs, practice staff and commissioners.

RCGP and the All Wales Diabetes Implementation Group are holding four half day events across Wales between November and December which will offer training for GPs to learn more about using Quality Improvement in diabetes management. Events are designed for all GPs, Practice Nurses, Managers and other members of the practice team. Further details can be found here.

• National Diabetes Audit

Through 2015-16, RCGP QI clinical leads worked with local clinical leads in 3 CCGs and one Welsh Health Board to implement improvements to the care of people with diabetes as part of the National Diabetes Audit (NDA). This informed the production of the Quality Improvement Toolkit for Diabetes Care supporting CCGs and clinicians to bring about change at practice level.

• QI Safeguarding Adults and Children

With funding from NHS London to build on the existing children and young people’s toolkit, and to develop a similar model for adults, the repeat of the multi-site child safeguarding audit undertaken in 2012 by the RCGP and the Institute of Child Health and Surrey University will result in a comparable audit and analysis into how London GPs record information around children safeguarding issues.

• National Cancer Diagnosis Audit (NCDA)

Working with Cancer Research UK, this audit aims to help review practice processes and improve cancer outcomes. The audit will look at cancer diagnosis and implementation of clinical standards to inform delivery of best care for cancer patients.

- NCDA objectives
- Frequently asked questions about the NCDA

• RCGP Clinical Practice Research Datalink Pilot

The Research and Surveillance Centre (RSC) has joined forces with the Clinical Practice Research Datalink (CPRD) in an exciting project that aims to:

- Develop innovative uses of primary care data that will improve the quality of care delivered to patients.
- Support and facilitate quality improvement via data reports tailored to individual practice populations.

The data reports will:

- Focus on prescribing and patient safety
- Enable benchmarking against other participating practices
- Enable case-finding of individual patients in your practice whose care may need review

These resources will be distributed at no cost to practices that sign up to contribute data to CPRD’s research database.

We are still actively recruiting pilot practices to shape the project, by giving feedback on the content and format of reports. To join in, please contact David Mullett at the Research and Surveillance Centre at david.mullett@rcgp.org.uk

Case studies

Here are some examples of QI in General Practice, from some of our QI Clinical Leads, that could be replicated in your practice:

Haxby Prospective Review Of Patient ACcess, Time Management and Workload to ImproVe Efficiency (PROACTIVE) Project

Vasectomy service in primary care

Implementation of paramedics in a GP setting

This list will be updated regularly.

GP Trainee Quality Improvement Project (QIP)

Engagement with Quality Improvement activities is a mandatory part of the curriculum for GP trainees ('Gold Guide' Reference Guide for Postgraduate Specialty Training in the UK, 7.32) and has become an established part of UK general practice.

Those  who have undertaken such activities have found it a worthwhile educational experience relevant to their future everyday work as a GP. It can help to develop skills in leadership and team working as well as in quality improvement itself.

For those who wish to undertake QIP, the following guidance outlines how trainees might approach such a project, a structure for receiving formative feedback from the educational supervisor, and some tips on how to avoid common pitfalls.

GP Trainee Quality Improvement Project (QIP)

Toolkits on Specific Clinical Areas

Toolkits home page

There are a wide variety of toolkits that the College has developed in partnership with a range of third sector leading bodies, government departments and clinicians. This is an ever-growing list of invaluable resources, signposting you to support for each clinical area.

Early diagnosis of Cancer Significant Event Analysis Toolkit 

Guidance for leads to extract themes from SEAs in order to make recommendations for quality improvement in general practice and across the primary-secondary care interface.

Quality Improvement Toolkit for Diabetes Care

Created from learning gained through the National Diabetes Audit (NDA), this toolkit aims to spread improvements in diabetes care more widely, including generic QI mini guides alongside material specific for diabetes care.

 

 

 

Useful links and other resources

The following are a selection of resources and background documents developed by a wide variety of sources. While all are not RCGP endorsed, we continue to review other resources and methodologies out in the field with a view to bringing them more formally into this toolkit.

‘Why Quality Improvement?’ Video
Dr Mike Evans explains why you should care about quality improvement, presents a brief history of quality improvement, touches on system design, the Model for Improvement, and the familiar challenge: 'What can you do by next Tuesday?'. Also see a brief animation by Nicola Francis from the London College of Communication to use in presentations.

RCGP Guide to Quality Improvement
A guide to make the principles and tools of quality improvement as accessible as possible for GPs and practice teams.

Data sources useful for Quality Improvement
A reference sheet detailing using data sources of comparative data.

Undertaking Quality Improvement
An overarching guide on resources available, with online materials, courses and books you can turn to for support in your quality improvement work

NHSI Directory of Online Quality Improvement Tools

QI Session at RCGP Conference 2015

Clinical Audit Surgery Posters

We have produced a series of posters and animations in partnership with the London College of Communication to promote effective audits. These can be used in your surgery.

Clinical Audit Cycles - A Practical Guide [PDF] and animation

Are You Deciphering Information Thoroughly? [PDF]

The Four Stage Spiral of Clinical Audits [PDF] and animation

Background

Helping you to provide the best possible quality of care

All GPs strive to provide the best possible quality of care for their patients and communities. In practice this means: 

  • Person Centred - acting in ways that demonstrate kindness and empathy, listening and sharing decisions in line with patient preferences.
  • Providing Access - ensuring access to advice and services which meets the timely needs of patients. 
  • Clinical effectiveness - providing clinical care for defined problems and diseases based on the most relevant scientific evidence, keeping up to date with advances in medical science and delivery of services.
  • Holistic Care – reviewing the whole patient, caring for multiple physical, psychological and social problems simultaneously and understanding the impact of each on the person.
  • Patient Safety – minimising any harm that might result from actions.
  • Equity – addressing the needs of more vulnerable members of the community in order to reduce inequalities.
  • Efficiency – achieving the best possible value for money and avoiding waste.
  • Knowledge and Resources – working in networks and teams, making appropriate referrals that navigate patients effectively through the complexity of the NHS.
  • Community – understanding the needs of communities and patients.

Whilst each needs to be recognised separately, and each require different measures and different assessment skills, in the context of the College and its role in quality and its improvement, the quality of the experience of the care giver should also be taken into consideration.

It is not possible in the real world to achieve excellence on all of these dimensions all of the time. People aren't able to consistently operate at the top of their game and often what they can do is constrained by factors that aren't within their direct control. People need to be supported and to feel valued in order to do their work well. In addition, there are inherent tensions between the different dimensions, for example between implementing some evidence based guidelines and supporting patients to choose what care they want to receive, and between providing good access and the costs of doing so.

Our ethos

The College recognises its role in taking the initiative around the quality agenda, and that there is a need to reflect our member’s experiences rather than focussing solely on the gold standard level of quality. ‘What good looks like’ changes over time and we want to encourage all members to engage in Quality Improvement (QI) activities on a broader level of continuous improvement, supporting the whole membership irrespective of where they are on the quality spectrum.

By being proactive on the quality improvement agenda we can provide the support needed by GPs and practices to continually improve patient care, assisting struggling practices and also supporting practices at the “excellence” end of the spectrum and at every level in between.

We have developed a framework using these principles which will evolve over time, just as the QI activities members undertake change and increase. This means we will: 

  • Encourage and enable the profession to build capacity and skills for continual quality improvement.
  • Create local support to share experiences and learning through informal and formal structures such as collaborations, peer review and support groups. 
  • Continue to develop the College’s Clinical Innovation and Research Centre as the centre of expertise for continuous quality improvement for primary care.
  • Ensure that the essential support for leadership in primary care is well integrated with the work on continuous quality improvement.
  • Ensure that the College uses its influence with the other national bodies including regulators, commissioners and government departments in all four countries, to provide unified, co-ordinated support to primary care.
  • Utilise the full range of expertise available to the college through its membership and its key NHS stakeholders in the development of the framework.
  • Ensure that the patient, carer and the public are involved in the development of the strategy.
  • Develop the framework using the principles of quality improvement, ensuring the framework is embedded in the culture and current context of primary care, utilises the QI cycle, patient involvement, stakeholder involvement and grounded in improvement science.

The development of this approach allows us to lead the conversation on quality in primary care with you as a member. There is an opportunity to use the numerous tools and expertise through members to build the quality improvement capabilities and leadership within the profession. Support to the profession in this area is aimed at all members of the practice team and include comprehensive help and resources for anyone who wants guidance or help about quality in primary care.

For further information or to contribute to these resources please contact QualityImprovement@rcgp.org.uk.

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