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ELITE quality improvement programme releases 2.6% GP capacity at Gillingham South PCN

Participating in the ELITE quality improvement programme, Gillingham South PCN used the APEX GP BI tool to understand and improve their practice performance. The resulting improvement project, concentrating on the triage process, aimed to reduce avoidable GP appointments. The changes implemented enabled them to release 2.6% capacity of GPs time, equivalent to an annual saving of £40,100. 


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Overview

Gillingham South are a PCN in Kent and Medway ICS with a 40,000 patient population and six practices of varying sizes including three single-hander GPs and one double-hander GP practice. The PCN participated in the ELITE quality improvement programme, sponsored by NHS England South East region, and delivered by South, Central and West.

The programme utilised the APEX GP BI tool to allow PCN and practice staff to better understand and measure improvements in performance. For their improvement project, the PCN chose to concentrate on improving the triage process, aiming to reduce avoidable GP appointments in order to help them support demand, giving time back to practice appointments. The changes implemented enabled the team to release 2.6% capacity of GP's time, equivalent to an annual saving of £40,100 – this released capacity was left in place to benefit patients which means there are now 2.6% more “unavoidable” appointments available to their population (access has been improved). The PCN reported that this was the first time they had worked this closely together on an improvement project.

Challenge

GP practices and PCNs have historically lacked the tools, and/or capacity to access their data for demand and capacity planning and improvement. Gillingham South PCN had a keen interest in improvement having invested in a quality improvement lead and team. The whole PCN had APEX installed as part of an initiative across the Kent and Medway ICS and they wanted to understand how they could maximise the value.  

One of the objectives of the ELITE Programme in looking at demand and capacity is to release 2% of GP or nursing capacity, using data from the APEX tool. To achieve this an opportunity analysis was undertaken to quantify opportunity areas of at least 2% that could be unlocked in the timeframe of the programme for the PCN. For Gillingham South, the largest opportunity was in “avoidable appointments” where a weighted average of 22.3% of GP appointments were assessed as being avoidable based on 1-2 weeks of audit data.  

Solution

ELITE follows a structured process of exploring opportunity analysis and generating improvement ideas at practice level before coming together as a PCN to agree and implement a single improvement project. This is carefully facilitated and supported by ELITE coaches.   

Gillingham South’s SCW ELITE coach reviewed the opportunity analysis with each practice in turn and undertook some light touch process mapping to start to generate hypotheses about potential improvements. The PCN then came together to agree which opportunity to focus on and what they would do as their improvement project with the  ELITE coach producing the analysis and the aggregated improvement hypotheses discussed at practice workshops. Avoidable appointments was the obvious target for Gillingham South as it was the largest opportunity for all practices. Of the hypotheses discussed, the two most favoured were improving the triage process, and improving messaging to patients, particularly about the new Additional Roles and Reimbursement (ARRS) positions (i.e. setting expectations about not seeing a GP).  The PCN decided to concentrate on the triage process as there was already significant patient communication underway about COVID programmes which could reduce the impact of this intervention. 

The PCN worked together to produce communal guidance for reception/admin staff in triage decisions. This included mapping the triage process at constituent practices before producing and agreeing a single, representative process map and set of guidance on conditions. Training was delivered to reception/admin staff in how to use the guidance and the practices now use this for new receptionists and refresher training. The ELITE coach provided support and analytical outputs (statistical process control charts) at weekly meetings to review progress on the impact. Qualitative feedback reviews were undertaken by the  ELITE coach at the end of the project to understand and record the practices’ experience, and the impact of the programme for a case study.  Finally, a “programme review” was undertaken with the whole PCN, reviewing and discussing the case study and then covering future improvements that might be undertaken – The Menti survey tool was used to gather and discuss ideas for future projects.

 

*LARC = long-acting reversible contraception service, PSA = prostate serum antigen 

Impact

Quantitative impact across the PCN

 

The table shows the quantitative impact for those practices that participated in the ELITE programme in terms of the GP capacity released.

• % capacity released across the PCN was 2.6%

• equated to 2.0 clinical sessions per week

• giving an estimated annual £ cost benefit of £40,100.

 

Qualitative impact

 

Practices were asked for feedback on their participation in the ELITE programme. The charts show the results. Answers were collated per practice so numbers on the pie charts correspond to the number of practices answering this way – with one answer per practice.

• All practices strongly agreed or agreed that the ELITE QI process helped them identify opportunities to improve.

• 5 out of 6 practices agreed that ELITE had improved joint working across the PCN

• 100% of the PCN's practices said they would recommend ELITE to other PCNs/practices.

“Learning through doing in the workplace is way more impactful [than theoretical learning]” – Woodlands Family Practice

 "We are no longer trying to squeeze extra GP appointments in at the end of the day “- The Glebe

To find out more, contact the ELITE programme team - Jason Retter, Digital Transformation Consultant - This email address is being protected from spambots. You need JavaScript enabled to view it. and Alison Goddard, Digital Programme Manager - This email address is being protected from spambots. You need JavaScript enabled to view it.

 🔊 EVENT: Primary Care Conference

📅 22 February 2023
🕧 09:00 - 17:00, SCW session at 14:00-15:00, London Wall Suite
 📍  London, EC2M 3YD

 

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