Improving General Practice

1
Improving General Practice

• Using Development Schemes

2
Quality Improvement Schemes

• Personal Schemes
• Membership By Assessment
• Fellowship By Assessment

• Practice Schemes
• Quality Team Development
• Quality Practice Award
• Research team assessment

3
Quality Improvement Schemes

• Criteria
• Standards
• Formative
• Summative
• Self administered
• Local Supporters
• Assessors

4
NHS Quality Scheme

• Short term it is the contract and QOF
• This is an Outcome
• Summative
• High trust environment
• Leaves process to the practices
• Single annual assessment

5
Change Process Used In The Contract

• Design
• Presentation
• Incentives
• Created Ownership
• Variable
• Decided by Practices

6
Improving General Practice

• What is General Practice what is to be improved
• Professional
• Practice unit
• Team of people
• Who is best to help practices
• Other clinical areas important
• Other management areas important

7
Improving General Practice

• Is being achieved
• Variability of method used to run the practices
• ? Some practices achieving by chasing individual
  tests / examinations
• Needs underlying administrative changes
• Can achieve QOF without change
• Will not be enough for future challenges

8
Improving General Practice

• In place
• Summative QOF
• Summative Assessment Visit
• Required for future
• Systems Change
• Formative Support
• Ownership of System Change
• New Skills and Attitudes

9
Improving General Practice

• Practitioners
• Multiple professional groups
• Clinical abilities
• Managerial abilities
• Where are we going, what is the vision for the
  task of practices

10
Improving General Practice

• Clinical Journey
• Reactive to patient need
• Small
• Doctor based
• Improving and employing new staff
• Much change
• Adding new clinical systems
• Steady state acute and chronic disease management
• Running a team
• Introducing people to established systems

11
Improving General Practice

• Managerial Journey
• Reactive to patient need
• Interpersonal skills
• One person can decide and manage for the business
• Improving and employing new staff
• Business planning and coordination
• Adding new control systems
• Steady state acute and chronic disease management
• Keeping everybody happy and performing
• The managed environment with team of managers

12
Improving General Practice

• Find out what needs to change
• Blocks to change
• Support scheme which
• Provides ideas and support around management
• Involves practices
• Involves different clinicians / staff
• Continuing input
• Focuses development on real tasks
• Develops leadership skills amongst the GPs and
  others

13
Improving General Practice

• Tools to use
• QTD, QPA
• The Quality Team Development (QTD) program is a
  team appraisal with a comprehensive evaluation of
  clinical governance processes in a practice.

14
Improving General Practice

• Dudley Scheme
• Practice Manager with Special Interest
• Developed and change QTD to longer term support
  and development around the specific tasks
• Is formative support for a summative QOF

15
Improving General Practice

• Requires more
• Which managerial job role for the clinician
• Leadership
• Management
• Administration
• Which job role for the manager
• Tools
• nGMS Contract Management Competences
• NHS Leadership Qualities Framework

16
Improving General Practice

• Existing development in Mersey
• MAP and FBA trained doctors
• Links to IHM
• Work with others in area of challenging practice
  (e.g. LMC, BIDA, Small Practices Association,
  PCT)
• Set out vision of future practice
• What needs to change to make it happen?
• Find out why getting there is difficult? (blocks
  to development)
• Develop a local QTD scheme by negotiation
• Add leadership element
• Progressively move the GPs to leadership and
  bring in others to share clinical task, manage
  and administer

17
Improving General Practice

• Requires external funding
• Parts require academic review and evaluation
• Improving quality in challenging areas should be
  a priority
• Will develop over time
• Ideas useful more widely
• Joint working with other organisations

18
Improving General Practice

• Next Steps
• Describe the idea in detail for costs
• Which organisation will house it ? Mersey Faculty
  RCGP
• Agreement from local GPs and organisations to
  participate
• Cost the scheme
• Cost the process to find the problems and
  evaluation
• Individuals to support the process
• Funding body

19
Improving General Practice

• Formative support
• scheme targeted at
• the more challenging
• practice areas

20

Improving General Practice

• QTD AIMS
• engage all members of the practice team in
  clinical governance
• identify those things the practice does well and
  prioritise areas for improvement
• support practice teams in finding solutions and
  improving the quality of their service
• provide a firm basis for practice development
  planning
• support achievement of the Quality and Outcome
  Framework
• improve team morale
• act as a catalyst for change
• provide a framework for reviewing practice roles
  and structures

21
Improving General Practice

• Example Criteria QTD
• Health needs and inequalities
• a) The practice plans and evaluates how their
  services are designed to meet the needs
• of their patient population.
• b) The team is aware of the priorities in their
  Local Health and Modernisation Plan.
• c) The team has a structured approach to
  addressing health needs and inequalities
• which includes-
• i. Developing services that meet the needs of
  vulnerable patients.
• ii. Ensuring that vulnerable groups are
  encouraged to participate in health
• promotion activities, such as breast screening,
  cytology, smoking cessation
• and other healthy lifestyle programmes.
• iii. Working with its PCO and other agencies on
  community development
• initiatives that endeavour to meet the health
  needs of patients.

22
South Dudley PCT Enhanced Service Consultancy

• Outcomes
• To facilitate local practices achieving Quality
  Team Development. To improve the quality of
  management in those practices. To implement a
  program of management training for practices. To
  involve General Practitioners in the management
  process and raise their awareness of the skills
  and capabilities of practice management staff. To
  improve practice managers competence.
• How the need was identified
• A practice manager identified a need for
  practices to work together and share information.
  The practice had successfully completed Quality
  Practice Award of the RCGP and felt the award or
  one like it had the potential to assist other
  practices in the area.The manager took the scheme
  to the PCT and colleagues and requested financial
  and other support. The Practice manager
  negotiated changes to the QTD scheme to allow an
  extended period of joint working and joint
  management development.

23
South Dudley PCT Enhanced Service Consultancy

• Description of service
• A minimum of four members of each practice team
  were brought together on a monthly basis to
  discuss ideas about how to improve specific
  servicesRepresentatives from 19 out of 35
  practices in the PCT agreed to take partThe
  practice members meet in initially two groups and
  now one large group for 3 hour sessionsSessions
  take place in the regular protected learning time
  of the practices. Costs of attendance are funded.
  GP attendance was felt crucial and their time is
  funded at locum rates.One or more practices
  presents ideas and their solution to the issue
  being discussed and others discuss and produce
  their own ideas.The sessions function to produce
  options for dealing with the issue in hand and as
  a general forum to use the issue to disseminate
  management theory. Confidence among managers and
  respect for colleagues has improved. This has led
  to a step change in management ability amongst
  the group.Egalitarian principles were followed
  with backfill of time spent but no formal titles
  or power was sought or given a group of equals
  working to share experience on a common task.The
  process was occurring at the same time as nGMS
  implementation. The overlap between the criteria
  assisted the practices and was felt beneficial.
• How the service was developed and funded
• The PCT made a grant of 50,000 for the scheme.
  This pays for the backfill of 75 a month for the
  two managers running the scheme. The costs of QTD
  and assessment are included as are the costs of
  venues and food. The cost of food is defrayed by
  sponsorship. Some backfill costs for attendance
  are paid (principally the GPs).
• Evaluation and the future
• The scheme is evaluated in two ways. The
  practices are assessed for QTD at the start and
  end of the scheme. Evaluations by questionnaire
  at 3 and 6 months were extremely positive. The
  scheme is coming to the end of the first year and
  practices are developing a new list of criteria
  to work with in a second year. All bar 2 of the
  non-participating practices are starting the
  scheme under the initial scheme.
• Contact
• Sonia ClarkPractice ManagerMoss Grove Surgery15
  Moss GroveKingswinfordWest MidlandsDY6
  9HS Telephone [phone]Email
  sonia.clark_at_dudley.nhs.ukClaire RipperPractice
  ManagerDr. Sumaria PartnersAlbion
  StreetBrierlery Hill West Midlands Telephone
  01384 77382Email claire.ripper_at_dudley.nhs.uk