West Wakefield Primary Care Network


Taking small steps to deliver big change.
All in a day’s work for JFA.

Services: Service Improvement (PDCA Cycle)

The Challenge:

To deliver real and lasting change, at pace, as part of the NHSE Productive General Practice Quick Start programme. Working under our Associate model, as Improvement Coaches for Qualitas Consortium UK, we were tasked to provide quick to action improvement to reduce ‘pressure’ in the system and release efficiencies. There were three objectives to consider and 6 weeks to do it all in.

Objective 1

Introduce strategies to increase the identification of carers registered at the Practices and their needs.

 

Objective 2

Deliver a shared IT system to create effective ways of working across the network. For example, to run reports, searches and deliver shared projects such as clinical pharmacy services. The system also needed to offer a standardised set up, extended hours, extended access and collaboration with wider stakeholders such as district nursing.

 

Objective 3

Reduce the workload for Practices. Including creating pro-active approaches and consistent messages around self-care and over the counter medications. Backed up with systems to ensure resources and information are easily accessible by both Practice staff and patients. Plus create processes for reviewing the data available around prescribing and look at ways to improve outcomes as a team.

Our approach
Getting the right people involved and engaged from the start.

This 6-week programme of service improvement support involved working with small groups of clinical staff, Practice Managers and other non-clinical staff to explore and then implement small steps that would deliver the required outcomes.

Each week, three half-day facilitated workshops per workstream were delivered, working with representatives from the 6 surgeries/medical centres, coaching them in quality improvement to address each project strand.

Implementing the Plan-Do-Check-Act (PDCA) approach, each group collected base-line data at the start of the project to help measure improvement, considered relevant processes and approaches to improve the situation, and implemented as many of the steps as possible. Post-project data was gathered, or projected percentage improvements were calculated, to consider the level of impact the changes would make.

The Results:

Objective 1:

The following were achieved to help identify and support Carers:

  • Practices completed the Care Quality Markers assessment
  • Improved systems around identifying carers and their needs
    • Changed the messaging to help identify more carers
    • Created a targeted campaign and pathway to help identify carers
    • Created a Carers survey to help identify their needs
  • Enhanced collaborative working between the Practices and other agencies, such as Carers Wakefield & District
  • Implemented the ‘Working Carers Passport’ across the 6 Practices
  • Identified Carers Champions within the Practices, to be trained to do the Carers’ assessments

 

Objective 2:

The following were achieved to:

  1. Reduce prescriptions for over the counter (OTC) medication
  2. Reduce primary care demand
  • Identified the top OTC medication groups (in terms of cost) being prescribed in each Practice
  • Developed GP Protocols to highlight OTC medications, including information for patients
  • Initiated a Self-care Competition for schools to promote self-care amongst the families of primary school children
  • Development of Self-care promotional materials
  • Patient Participation Group representatives were consulted regarding self-care, care navigation, OTC medications
  • A Target training session for PCN Reception and Administrative staff was facilitated,  considering self-care, and what pharmacies can / can’t prescribe
  • Strategies for raising awareness of self-care and OTC medication changes were planned, including campaigns and key messaging
  • Opportunities to work more collaboratively with community pharmacies and care homes to improve patient outcomes were identified

 

Objective 3:

The following were completed to facilitate collaborative working and offer resilience in the Primary Care Network systems

  • Process mapping for document workflow, to enable cross-Practice working and support

SystmOne – shared access Hub was tested and integrated across the PCN to facilitate appointment booking of shared resources including Clinical Pharmacists and Social Prescribers, as well as links with partner organisations including Community Pharmacies and Care Homes

Feedback

We received some amazing comments from the Reception and Admin staff. They highlighted these key improvements:

  • Developed much more knowledge and understanding. e.g. about Carers etc.
  • Group communication has been extremely beneficial
  • Sharing ideas has been great
  • Small groups facilitated conversations and sharing of ideas
  • Increased self-confidence
  • Learnt a lot about how other things are done in other Practices and changed approach at own practice, through listening to others

Dr Aly Damji (GP) @ Church Street:

“Everyone is trying to work together, progress together and learn together which was really nice to see.  This programme has given the practices a greater understanding of where they are currently and what they need to do to move forwards.”

“It got people together and focussed attention – really beneficial in making foundations and creating building blocks.”

“Carers don’t recognise that they are carers sometimes so early identification is really important and we’ve built this capability”

Eliza Cranswick: Admin @ Lupset

“I found the experience very positive as I have been able to improve my confidence in both speaking and putting my ideas forward in meetings and feeding back effectively to management.

“Nice to be involved in it and feedback to the Practice Manager, because as we do the job, we understand it better, what would benefit us and improve the process, rather than managers not doing it and understanding it, changing it without this understanding.”

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Jane Fisher Associates
01904 435 100 07837 024 374 hello@janefisherassociates.co.uk
Jane Fisher Associates Ltd
Management Consultancy & Training
Innovation Centre, Innovation Way
Heslington
York
YO10 5DG