QI in general practice: What do GPs and practice managers think?

Quality improvement in health image

16 January 2020

Bryan Jones, Improvement Fellow, The Health Foundation

In the last few years, interest among GPs in the use of quality improvement (QI) approaches and tools, such as QI Ready has grown sharply. The GP Forward View in 2016 picked out the development of QI expertise as one of 10 ‘high impact actions’, while the 2019/ 20 QOF in England has included QI modules for the first time. As Martin Marshall, RCGP Chair of Council, argued recently, QI has become ‘fundamental to general practice’.

While the profile of QI is on the rise, we have very little data about the level of QI awareness, knowledge and usage within practices. To help close this gap, the Health Foundation has funded research by the London School of Hygiene & Tropical Medicine (LSHTM). The research, which has just been published, involved a survey of over 2,300 GPs and over 1,400 practice managers across the UK. Interviews and other qualitative research was also included.

'Most GPs and practice managers see improving quality as a core aspect of their work'

The LSHTM research found that most GPs and practice managers see improving quality as a core aspect of their work. Almost all of them (99%) reported that their practices were involved in some form of improvement activity. For most of them, the driver for this work came from within the practice rather than from external prompts. Furthermore, many respondents (60% of GPs and 71% of practice managers) said they were working collaboratively with neighbouring practices to improve services.

But the LSHTM team also found a number of issues that are making it difficult for practices to deliver improvement. As well as the twin challenges of high patient demand and staff shortages, the level of external demands (such as reporting requests) and the time needed to handle them was a source of frustration for nearly all respondents. The demands of other NHS agencies were identified by 95% of GPs and 93% of practice managers as a key barrier to improvement. The lack of protected time to plan and design improvement (a key difference from QI in secondary care) also emerged as a major challenge for almost 80% of GPs.

Lack of skills to manage and analyse data a barrier to improvement in general practice

Another challenge highlighted by the research is the level of improvement capability within general practice. For example, only 20% of GPs and 33% of practice managers were familiar with Plan, Do, Study, Act (PDSA) cycles, which is perhaps the most widely used improvement approach in health care. Meanwhile, 42% of GPs and 51% of practice managers identified a lack of skills in managing and analysing data as being a barrier to improvement in general practice. On the plus side, the survey shows that 64% of GPs and 73% of practice managers would be interested in training in a wider range of QI tools and approaches.

What LSHTM’s research highlights is that, unless practice teams are able to carve out time to learn about and plan and participate in improvement, it will be hard for them to embed a QI culture. But for this to happen practices need active support from policy makers and sector leaders. They can’t be expected to do it alone.

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