Exploring innovation in GP Practices

BMA – 2023

What can we learn from innovations in general practice?

Despite current contractual, financial, and capacity constraints, GPs are innovating in different ways to deliver high-quality care and attract and retain staff.

In this collection of case-studies, we explore how eight GP providers around the country are implementing innovative models, from improving access to a wider range of services for patients to effective chronic disease management.

Read the Report – BMA report on innovation in general practice.

Delivery plan for recovering access to primary care

NHS England – 9th May 2023

This plan has two central ambitions:

1. To tackle the 8am rush and reduce the number of people struggling to contact their practice. Patients should no longer be asked to call back another day to book an appointment, and we will invest in general practice to enable this.
2. For patients to know on the day they contact their practice how their request will be managed.
   a. If their need is clinically urgent it should be assessed on the same day by a telephone or face-to-face appointment. If the patient contacts their practice in the afternoon they may be assessed on the next day, where clinically
   appropriate.
   b. If their need is not urgent, but it requires a telephone or face-to-face appointment, this should be scheduled within two weeks.
   c. Where appropriate, patients will be signposted to self-care or other local services (eg community pharmacy or self-referral services).

Delivery plan for recovering access to primary care

General practice and secondary care: Working better together

Academy of Medical Royal Colleges – March 2023

Much has been written about the challenges that occur at the general practice and secondary care interface. Some feel the problem almost pre-dates the NHS itself, while others point to the internal market and the purchaser provider split of the 1990s, others to the Lansley reforms of 2012. ‘Perverse incentives’ was also a frequent theme we heard
in making this report, as too were the ways general practice and secondary care receive payment for the work they do.
This report, some may say thankfully, does not seek to address any of those issues.

Instead, what is set out here is a compendium of practical and workable solutions designed by local systems to reduce the friction that inevitably occurs across this divide. Many are astonishingly simple and help improve patient experience and reduce the burden on clinicians and other NHS staff. We are grateful to all those who told us how they had implemented change and what it meant locally. There are numerous formats we could have used to present these findings, but for ease we have put the examples into three broad themes: Culture, Communication and Clinical
process. At the back of the report there is also an index which groups the examples by operational themes.

Read the Report – General practice and secondary care

Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers

Gosling, J. et al | 2021| Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers| BMJ Open Quality | 10 | e001309| doi: 10.1136/bmjoq-2020-001309

Abstract

Background 

This paper presents the results of the first UK-wide survey of National Health Service (NHS) general practitioners (GPs) and practice managers (PMs) designed to explore the service improvement activities being undertaken in practices, and the factors that facilitated or obstructed that work. The research was prompted by growing policy and professional interest in the quality of general practice and its improvement. The analysis compares GP and PM involvement in, and experience of, quality improvement activities.

Methods 

This was a mixed-method study comprising 26 semistructured interviews, a focus group and two surveys. The qualitative data supported the design of the surveys, which were sent to all 46 238 GPs on the Royal College of General Practitioners (RCGP) database and the PM at every practice across the UK (n=9153) in July 2017.

Results

 Responses from 2377 GPs and 1424 PMs were received and were broadly representative of each group. Ninety-nine per cent reported having planned or undertaken improvement activities in the previous 12 months. The most frequent related to prescribing and access. Key facilitators of improvement included ‘good clinical leadership’. The two main barriers were ‘too many demands from external stakeholders’ and a lack of protected time. Audit and significant event audit were the most common improvement tools used, but respondents were interested in training on other quality improvement tools.

Conclusion 

GPs and PMs are interested in improving service quality. As such, the new quality improvement domain in the Quality and Outcomes Framework used in the payment of practices is likely to be relatively easily accepted by GPs in England. However, if improving quality is to become routine work for practices, it will be important for the NHS in the four UK countries to work with practices to mitigate some of the barriers that they face, in particular the lack of protected time.

The full paper is available from BMJ Open Quality 

Enabling remote working for GPs and practice staff

Currently 30% of GPs are self-isolating, most are more than capable of working, but cannot access the systems they need, and this is putting huge stress on their colleagues and the primary care system.

Trustmarque and Microsoft have been working with NHS partners in the Midlands and London to use the power of Azure to solve this problem. This enables working on personal laptops or smart devices in a secure NHS environment. The Virtual Desktop has been built in the last two weeks and is currently being tested by GPs with plans to roll out to 1000+ within a week. Positive feedback has been received.

Full detail at Primary Care Commissioning

Video consultations: A guide for practice

In response to COVID-19, the NHS is scaling up the use of virtual consultations. Important new information and guidance is now available from researchers at the University of Oxford to support video consultations. 

COVID-19 creates an unprecedented situation. Many GP practices are considering introducing video consultations as a matter of urgency to reduce risk of contagion.

This document is packed with useful, practical advice and tips to help doctors, other primary care clinicians, and patients navigate these almost uncharted waters at a time of unprecedented challenge for the health service.

This preliminary document covers five questions:

1. When are video consultations appropriate in primary care?
2. How can a GP practice get set up for video consultations?
3. How can a clinician conduct a high-quality video consultation in primary care?
4. How should patients prepare for, and participate in, video consultations?
5. What is the research evidence for the quality and safety of video consultations?

Full document: Video consultations – a guide for practice

See also: Using virtual consultations in the fight against COVID-19 | Interview with Professor Trish Greenhalgh via Health Foundation

Improving primary and community care

Realising the neighbourhood NHS: delivering a new deal for primary care in England | The Institute of Public Policy Research

This paper provides new evidence and ideas to improve the provision of primary and community care.  It argues there should be a ‘new deal’ for general practice which should consist of:

• creating neighbourhood care providers to deliver the ‘neighbourhood NHS’
• offering all GPs the right to NHS employment
• reforming new GP roles to create career progression, time to care and realistic workload
• a radical transformation of the primary care infrastructure.

General practice guidance: online appointments

Practice guidance: offering 25% of appointments online | NHS England | NHS Improvement 

This short guide contains hints, tips and case study experiences to support general practices to make sure that at least 25% of their appointments are available to book online. It includes a full list of the types of appointments to include, important things to consider and configuration hints and tips.

Full guide at NHS England

How to build effective teams in General Practice

This guide draws on insights from research, policy analysis and leadership practice to outline ways in which practices can create and sustain effective teams, as they come together to form primary care networks | The Kings Fund

The need for collaboration and communication underpins much of the guide and links to further reading and case studies to support each section are provided. The guide looks at the following questions:

1. What are the fundamentals of effective teams?
2. Which roles should you recruit?
3. How can you make best use of new roles?
4. How can teams communicate effectively?
5. Do you need to re-design your physical space?
6. How can you ensure supportive management and accountability?
7. How can you work across organisations?
8. How should you engage with your patients?
9. ​How can you manage yourselves effectively?

Full document: How to build effective teams in general practice

Quality improvement in general practice

Quality improvement in general practice: what do GPs and practice managers think? | The Health Foundation

There is growing recognition of the importance of quality improvement in general practice. But what is the extent of knowledge and use of quality improvement tools and approaches in general practice across the UK?

This new report explores the level of quality improvement awareness, appetite and activity in general practice across the UK, through a survey of over 2,300 GPs and 1,400 practice managers, alongside qualitative interviews.

The report finds a high level of agreement from GPs and practice managers about what helps or hinders their work to improve quality. It also sets out how national and local system leaders can support those working in general practice to improve the quality of services they provide.

Full report: Quality improvement in general practice: what do GPs and practice managers think?