Key points from the research

This project provides a unique insight into the operation of general practice across the UK and how both GPs and practice managers are engaging with quality improvement (QI) within the landscape of the day-to-day pressures of high patient demand, workforce shortages and limited resources. The project findings draw on a survey of GPs and practice managers across the UK during the second half of 2017, which produced 2,377 responses from GPs and 1,424 responses from practice managers. This research found that:

  • Improvement is a common and ongoing process for the vast majority of practices, with only 16 GPs and six practice managers in the survey saying their practices were not undertaking any QI activities. Prescribing, access, chronic disease management, collaborating with other practices and end-of-life care were all selected by GPs and practice managers as the most common improvement areas.
  • Most practices do not have a single nominated lead to address QI. Usually the person leading depends on the type of improvement activity. This means that a wide range of practice staff are getting involved in QI work.
  • Practices are more likely to respond to prompts from within the practice to change or improve services than from external bodies. This suggests that practices are self-motivating and that improving quality is often normal practice. However, practices reported that demands from NHS agencies did not always support QI. Reporting requirements were often overlapping and required duplication of effort and were often not in areas that the practices wanted to focus on.
  • Key facilitators supporting quality improvements (Table 3.1) were:
    • working well as a team (98% of GPs and 97% of practice managers)
    • good clinical leadership (96% of GPs and 95% of practice managers)
    • clinical staff having the skills to assess service quality (94% of GPs and 93% of practice managers).
  • Extra external funding was only identified as helpful by 42% of GPs and 38% of practice managers. This could be because of the added bureaucracy involved in creating and submitting plans and reporting outcomes.
  • Key barriers to QI (Table 3.4) were:
    • high levels of patient demand (95% of both GPs and practice managers)
    • too many demands from NHS agencies (95% of GPs and 93% of practice managers)
    • clinical staff shortages (84% of GPs and 77% of practice managers).

These are probably not surprising as the key barriers. The level of demand from patients added to clinical staff shortages will inevitably restrict the time available for working on QI initiatives. They will also mean that it is harder to find the ‘headspace’ to be able to step back from day-to-day work to look at the practice and consider areas for improvement.

  • Access to protected time is crucial to enable teams to meet to work on QI. However, our data shows that very few practices have access to much protected time. This issue was identified as important to successful improvement initiatives by nearly 80% of GPs (Table 3.1). Protected time seems to have been whittled away by increasing workloads and, sometimes, external demands. Unlike secondary care, most practices do not have a formal infrastructure that allows protected time for training, including in QI.
  • While many GPs have been trained in Audit and Significant Event Audit, far fewer have been trained in QI tools such as PDSA (Plan, Do, Study, Act) Cycles, Root Cause Analysis and Process Mapping; for practice managers, too, only a minority have been trained in these tools. However, our survey found that nearly two-thirds of GPs (64%) and three-quarters of practice managers (73%) were interested in receiving training in the use of QI tools.
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