Collaborative Quality Improvement in Wales

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20 September 2019

Dr Karen Gully, RCGP Wales Quality Lead, Clinical Director (Primary Care) Aneurin Bevan University Health Board And  RCGP Wales Quality Lead

Quality improvement (QI) in Wales is a coordinated team approach that builds on the strengths of multidisciplinary working, recognising clinical leadership, and has several development programmes. This approach to implementing QI is helping to build network of expertise and enthusiasm that is needed to support the continuous improvement of services.

The RCGP in Wales supports seven GP Advocate roles. Each GP works with a nominated health board to raise the profile of RCGP Wales and highlight resources and expertise available through the wider College networks. This helps to increase awareness of the programmes and clinical resources available through the Clinical Innovation and Research Centre (CIRC). The Advocates also work closely with the three RCGP Wales Faculties and will help to inform the future work of the College to encourage and support the quality improvement focus in primary care.

NHS Wales places a strong importance on collaborative working

The Welsh government has a ten-year, whole system approach called ‘A Healthier Wales’, for health and social care. This plan places strong emphasis on preventing ill health and helping people to stay well. Its focus is on a community based, person-centred approach to minimise the need for hospital services and ensure prompt access when needed.

To achieve these aims NHS Wales places a strong importance on collaborative working. GP teams have been encouraged to work in ‘Clusters’ with neighbouring practices and local health and social care partners to understand local population needs then design services that work effectively and efficiently to address agreed priorities. Significant progress has been achieved in establishing these Clusters and agreeing priorities. This approach has helped to address sustainability issues in general practice and to support recruitment of more diverse multidisciplinary teams.

As the Cluster networks mature, there is an increasing focus on implementing quality improvement with participation from all members of the extended team in the networks, supported through national and local initiatives to help them implement QI.

Practices encouraged to share learning across Clusters to disseminate good practice

The Welsh GP contract has been used to support quality improvement projects for many years. National Clinical Priorities (including the reduction of polypharmacy and improvement of end of life care provision) were contractual incentives to encourage practice teams to reflect on clinical outcomes and patient experience to identify, and deliver, quality improvement actions. Practices were encouraged to share learning across Clusters to disseminate good practice.

The 2019 GP contract has replaced Quality Outcomes Framework (QOF) with a revised, improvement focused, Quality Assurance and Improvement Framework (QAIF). This includes the introduction of a “basket” of quality improvement projects to be delivered at Cluster level with a focus on patient safety. Two projects are required, one compulsory and the other selected by the practice from a menu of options. Health Boards will enable the delivery of these projects.

Other quality improvement programmes in Wales include:

  •  ‘Improving Quality Together’ (IQT), hosted by Public Health Wales, a national quality improvement programme for all NHS Wales’ staff and contractors, created to help them develop skills in quality improvement methodology.
  • The Bevan Academy for Leadership and Innovation provides a dynamic learning and development environment to support inspirational leadership, innovative ideas and new ways of working.
  • Local Improvement Hubs support health boards and trusts to develop physical or virtual networks to deliver local improvement capability and innovation. A National Primary Care Hub captures the learning from improvement projects, collates resources and hosts an Annual Primary Care Conference to share good practice and encourage networking and collaboration.
  • Developing Doctors to Deliver (The ‘3D Programme”), delivered by Health Education and Improvement Wales (HEIW) is a popular and well-established programme that promotes strong clinical leadership, designed to support professionals as they develop skills to improve and enhance patient care. 

Leaders for the Future programme

Further leadership development opportunities are available through the RCGP Wales ‘Leaders for the Future’ programme for GPs at all stages of their career, including First 5s, Locums, Partners, Salaried GPs and OOH doctors. The programme prioritises learning through experience and uses a variety of individual and group settings. The next programme commences in October 2019 and further details are available from lesley.hills@rcgp.org.uk telephone 020 3188 7759. 

For further information about quality improvement work in Wales contact the Regional Quality Improvement Champions, Dr Karen Gully Karen.gully@wales.nhs.uk  and Dr Sue Goodfellow sjgood50@icloud.com

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