Improving health and care at scale: learning from the experience of systems

via NHS Confederation

NHS England has outlined plans to develop an improvement approach – NHS IMPACT – to support continuous improvement. There are also ambitions for integrated care systems to become ‘self-improving systems’.

This report, written and researched by Sir Chris Ham and jointly commissioned by the NHS Confederation, the Health Foundation and the Q community, reviews the experience of a number of ICSs identified as being at the forefront of this work, focusing on the approaches they have taken and the results achieved.

Full report: Improving health and care at scale: learning from the experience of systems

Key points: Improving health and care at scale: learning from the experience of systems

Improvement as mainstream business

via The Health Foundation

Improvement approaches, which provide a systematic means of bringing about measurable improvements in the quality and outcomes of care for patients as well as care productivity, have been in common use in some health care settings for more than 20 years, often producing impressive results where they are deployed well. Yet approaches to improvement are far from being embedded into the core strategy and operations of every health care organisation or system-wide partnership of organisations.

This briefing examines why this is still the case, argues that embedding improvement approaches across all health care settings is now vital, and describes what needs to happen to shift improvement from the margins to the mainstream of health care.

Full detail: Improvement as mainstream business. The strategic case

Strengthening primary and community care services

Healthwatch

Staff in primary and community care settings are facing immense challenges, with both clinical and administrative workforce shortages combining with a rise in demand for increasingly complex care. This briefing shows how people’s experiences can be used to support the development of a long-term vision to strengthen primary and community care services.

The briefing analyses the experiences people shared with Healthwatch and identified what is working well and which areas patients want to see improved. Recommendations are made to help inform a future vision for primary care and drive efficiencies across the whole system.

Full briefing: Strengthening primary and community care services – the foundation for most care and treatment

A guide to making the case for improvement

via The Health Foundation

This guide is intended to help local organisation and system leaders make the case for investing in improvement approaches to achieve their delivery and performance goals. It will also be of interest to policymakers and regulators looking to incentivise improvement, and front-line staff and managers trying to tackle pressing quality and safety challenges and develop their skills. It describes a broad range of well-evidenced benefits that improvement approaches can deliver in key strategic and operational areas.

The guide is divided into four broad areas improvement approaches can benefit:

• the health and care workforce
• patients, service users and society 
• organisations
• system-level bodies

Specific examples are given for each area, illustrating the diverse and multi-faceted benefits that can flow from improvement approaches. This guide can be used to make the case for improvement to policy, executive, operational and front-line audiences, and to initiate and support conversations about the benefits of improvement approaches among key stakeholders.  

Full document: A guide to making the case for improvement

Supporting people living with Dementia: Evidence from research

Institute of Public Care

What good commissioning of support for people living with dementia and for their carers should look like is multi-layered and complex. It requires a long-term strategic commitment and ensuring wherever possible that support is evidence-based and informed. In addition to the central importance of health and care support, there are implications for wider commissioning and services including the built environment and transport for example. Commissioners and providers should consider how well their current service offer enables people living with dementia to participate in their communities as fully as possible, for as long as possible.

Our review explores a range of evidence on what can enable people to maintain independence and wellbeing, and how best to support people living with dementia to have a quality of life grounded on what matters to them, and to their carers and family members.

Full briefing paper: Supporting people living with Dementia: Evidence from research

NHS Impact: Improving patient care together

To support the implementation of the NHS Impact approach to improvement by provider, ICS and national leaders, this long read sets out five guiding principles and some recommendations | The Health Foundation

The NHS is facing an unprecedented range of workforce, financial and performance pressures. The time has come to think and act differently and to do so at pace. What is needed is a strategy and management system capable of maximising the impact and spread of the many promising NHS-led innovations, service improvements and new technologies.

The new NHS Impact approach to improvement could help to meet this need. It articulates the importance of taking an aligned and integrated approach to improvement delivery and capability building across NHS provider organisations and integrated care systems (ICSs). Carefully implemented it could help to tackle the NHS’s most entrenched challenges, such as improving flow along urgent and emergency care pathways and improving GP access.

Full detail: Five principles for implementing the NHS Impact approach to improvement in England | The Health Foundation

See also: NHS Impact | NHS England

GP bureaucracy busting concordat launched

Department of Health and Social Care

A new bureaucracy busting concordat has been published by the Government. It sets out seven principles, which were developed with input from the British Medical Association (BMA) and Royal College of General Practitioners (RCGP), that aim to reduce unnecessary bureaucracy and administrative burdens, ensuring that clinicians have more time for patients. These include encouraging digitisation, increased co-design and the use of other relevant professionals wherever possible.

Full detail: Bureaucracy busting concordat: principles to reduce unnecessary bureaucracy and administrative burdens on general practice

Reducing the disease burden for hypertension

Reducing the disease burden for hypertension – how an integrated approach is improving patient care | via UCLPartners

In this video case study GP Dr Vaishali Ashar, and Health and Wellbeing Coach, Darshana Lithagra, discuss transforming care for their patients by implementing the UCLPartners Proactive Care frameworks. They discuss the process and give a patient example of how it can work in practice, demonstrating how an integrated approach can improve patient care.

Reducing missed appointments in general practice: evaluation of a quality improvement programme in East London

British Journal of General Practice | January 2021; Volume 71,Issue 702

Abstract

Background Missed appointments are common in primary care, contributing to reduced clinical capacity. NHS England has estimated that there are 7.2 million missed general practice appointments annually, at a cost of £216 million. Reducing these numbers is important for an efficient primary care sector.

Aim To evaluate the impact of a system-wide quality improvement (QI) programme on the rates of missed GP appointments, and to identify effective practice interventions.

Design and setting Practices within a clinical commissioning group (CCG) in East London, with an ethnically diverse and socially deprived population.

Method Study practices engaged in a generic QI programme, which included sharing data on appointment systems and Did Not Attend (DNA) rates. Fourteen out of 25 practices implemented DNA reduction projects, supported by practice-based coaching. Appointment data were collected from practice electronic health records. Evaluation included comparisons of DNA rates pre- and post-intervention using interrupted times series analysis.

Results In total, 25 out of 32 practices engaged with the programme. The mean DNA rate at baseline was 7% (range 2–12%); 2 years later the generic intervention DNA rates were 5.2%. This equates to a reduction of 4030 missed appointments. The most effective practice intervention was to reduce the forward booking time to 1 day. The practice that made this change reduced its mean DNA rate from 7.8% to 3.9%.

Conclusion Forward booking time in days is the best predictor of practice DNA rates. Sharing appointment data produced a significant reduction in missed appointments, and behaviour change interventions with patients had a modest additional impact; in contrast, introducing structural change to the appointment system effectively reduced DNA rates. To reduce non-attendance, it appears that the appointment system needs to change, not the patient.

Full article: Reducing missed appointments in general practice: evaluation of a quality improvement programme in East London

Reimagining community services

The King’s Fund has published Reimagining community services: making the most of our assets.  This report looks at the current state of community services and explores how the health and care system needs to change to enable these services to meet the needs of the population now and in the future.  It proposes ten design principles that should inform the future planning and provision of care.