Quality Improvement (QI) at the RCGP

What is Quality Improvement?

Quality Improvement (QI) helps us identify what works well and where we can make changes. 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 is a commitment to continuously improving the quality of healthcare, focusing on the preferences and needs of the people who use services.

How will QI help me and my team?

  • It's evidence based
  • It saves time
  • It improves GP practice systems and use of resources
  • It leads to better outcomes for patients
  • It's useful for all practice staff
  • It supports practices performing at all levels

The College recognises its role in taking the initiative around the quality agenda, and that there is a need to reflect our members' experiences rather than focusing 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.

For further information contact QualityImprovement@rcgp.org.uk

Webinars

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.

The experience of improving diabetes care – 15 December 2016

This webinar explored issues surrounding improving the diabetes care using Quality Improvement methods and tools. The webinar gives an introduction to QI tools and methods. looks at their use in practice setting, and points to available resources.

The session was chaired by Dr Bill Taylor (College QI Clinical Lead), on the panel were Dr Joanna Bircher (College QI Clinical Lead) and Dr Andrew Askey (CCG clinical lead for diabetes and LTCs, Walsall CCG).

View the presentation here and view a video of the webinar here.

How Quality Improvement can positively impact on patients with diabetes – 12 January 2017

This webinar followed ‘The experience of improving diabetes care’ and further explored issues surrounding improving care for patients with diabetes. The webinar focused on patient experience and how Quality Improvement methods and tools can help practices put patients at the centre of care.

The session was chaired by Dr Bill Taylor, on the panel were Dr Joanna Bircher, Paul Gimson (National Primary Care Programme Manager, 1000 Lives Improvement Service, Public Health Wales), Dr Lesley Surman (Patient Participation Expert) and David Roberts (Patient Representative, Diabetes UK).

View the presentation here and view a video of the webinar here.

Motivating others to take part in Quality Improvement - 9 February 2017

This webinar followed 'Sharing practical experiences of Quality Improvement' and provided more information on the new self accreditation and online learning network, QI Ready, alongside sharing tips on motivating members of your practice in quality improvement.

The session was chaired by Dr Becks Fisher (The Health Foundation) and on the panel were Dr Joanna Bircher, Dr Bill Taylor, Dr Mike Holmes (College QI Ready Lead) and Dr Simon Stockhill (College QI Ready Lead).

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 your 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.

QI guide and 'How to' tools

This guide details the overarching background and context to all things 'QI' in general practice.

Before and after - a practical guide on identifying smarter ways of working, allowing change to be introduced in a considered way and on a manageable scale

Links to UK-wide data useful for undertaking QI activities.

Allows practices to analyse data, with minimum use of statistical methods, to determine if an improvement has been made.

A visual tool that assists teams to analyse and streamline processes, helping to save valuable time.

 

Current QI Projects

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

  •  Acute Kidney Injury

 Clinical Champion: Dr Tom Blakeman

Working with Dr Tom Blakeman (The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC), Greater Manchester), Think Kidneys; and Dr Edward Kingdon from the Kent Surrey Sussex Academic Health Science Network (KSS AHSN) this project will build on the work of the 2013 – 2016 RCGP Clinical Priority in Kidney Care to improve the recognition of and response to Acute Kidney Injury (AKI) in primary care.

  • Inflammatory Arthritis

Clinical Champion: Dr Daniel Murphy 

This project, run in partnership with the British Society for Rheumatology (BSR) and other stakeholders, will see to improve the lives of people with inflammatory arthritis by reducing delays to treatment and optimising shared care pathways and drug safety.

  • Good Practice Safeguarding

Clinical Champion: Dr Joy Shacklock 

Building on the work of previous years the College is taking forward a project focusing on Good Practice Safeguarding for Adults and Children. Resources from our 2016/17 Safeguarding project are available.

  • 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. See an example report regarding prescribing of NSAIDs and glitazones in patients with heart failure. To join in, please contact David Mullett

 

For further information on our current QI projects, please contact Lauren Harding

QI Toolkits

The College has developed a wide variety of toolkits in partnership with 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.

GP Trainee Quality Improvement Project (QIP)

Engagement with QI 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.

This guidance outlines how to approach such a project, a structure for receiving formative feedback from the educational supervisor, and some tips on avoiding common pitfalls.

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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