Quality Improvement: A team approach to improving clinical effectiveness in Southwark

01 November 2019

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01 November 2019

Dr Payam Torabi, GP and Clinical Lead for Clinical Effectiveness Southwark

We all know what a busy environment primary care can be. GPs have over 200 guidelines per year relevant to their clinical practice – implementation can feel like an uphill struggle. There is huge variation in the quality of primary care provision. It can be hard for practices to know how they are doing, and difficult to find time to share learning and best practice with colleagues.

In Southwark, the Clinical Commissioning Group (CCG) and GP federations have come together with local stakeholders including the Health Innovation Network, Health Watch Southwark and King’s Health Partners to tackle these problems.

Supporting practices to improve quality for 20 years

For 20 years, the Clinical Effectiveness Group (CEG) in East London has been providing support to practices to improve quality, leading to some of the best results nationally, despite their levels of economic deprivation being among the highest in the country. Clinical Effectiveness Southwark (CES) was set up in 2017, with the support of funding from the Health Foundation’s ‘Scaling Up Improvement’ programme, to adapt the CEG model to Southwark’s local context.

The approach involves collaboratively prioritising and agreeing on clinical areas to focus our attention on, considering local needs and resources. Once we have done this, we co-develop local guides, summarising and synthesizing the available evidence in collaboration with local primary and secondary care supported by our Medicines Optimisation pharmacists. These guides are used as part of educational events where about 150 clinicians come together to learn from across Southwark general practices. Practices are also supplied with electronic health record templates and pop-ups to support with consistent data entry and remind clinicians of key things to remember during consultations. None of our templates have mandatory fields, meaning clinicians retain full autonomy regarding their use.

Increasing awareness of resources available to implement change

An issue with measuring quality and feeding back in primary care is inconsistent coding. Using the templates and pop-ups ensures data is entered into the system consistently enables high-quality analytics. Useful analytics need not mean hi-tech solutions – we currently use a Microsoft Access database. One of the biggest challenges has been clarifying and agreeing search terms and clinical codes to use. This has usually meant a clinician and an analyst sitting and working together to develop clear and relevant criteria for each clinical area.

Once we have data to present back to practices we arrange individual and neighbourhood facilitation visits via the local GP federations where practices have the opportunity to review their data and share learning. These visits are often where we see the biggest impact, through increasing awareness of the resources available and supporting practices with implementing change on the ground.

All the clinicians in CES work in local practices so they can build relationships and work directly with our products. Our analyst also works with one of the GP federations. We have already contributed to improvements in diabetes care in Southwark and indications are that variation in practice is reducing. As a project partner, King’s College London is producing a robust evaluation of our work, but the initial evidence on the ground is that we are living up to our strapline ‘making the right thing to do, the easy thing to do’ for busy clinicians.

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