Improving Together: A National Framework for Quality and GP Clusters in Scotland

NHS Education Scotland and the Scottish School of Primary Care
Personal Development, Learning and Research

Across Europe, there are examples of small groups of health professionals who meet together regularly to disseminate learning in primary care. This is an important function of GP clusters, facilitating improvement in measurable quality (eg harmful prescribing), but also learning through audit, adverse event review, human factors and ergonomics, decision support aids and educational materials .

NES have a variety of learning resources based on a blended learning approach to include Workshops, E-learning, Train-the-Trainer sessions and Formative Assessment. These resources aim to support Multi-Disciplinary Education and Training which can be adapted to suit the appropriate healthcare professionals involved.

Examples of resource include:

Leadership Development
Facilitation Skills
Understanding Why Things go Wrong in Complex Systems
Enhanced Significant Event Analysis
Patient Safety in Primary Care
Evaluation of Improvement Interventions; Qualitative and Quantitative Methods
Prospective Hazard Analysis
Incident Reporting and Learning Guidance

Quality Improvement Skills
Human Factors and Ergonomics
How to Respond When Things go Wrong
Systems Thinking and Approaches
Safer Systems for Test Results Management
QI Tools (e.g. Care Bundles, Audit, PDSA Cycles, Trigger Review, Safety Checklist)
Process Mapping
Safe Practice in Medicines Reconciliation

In addition, there are a number of validated safety and improvement tools that NES have developed which may be useful to GP practices and clusters when assessing and planning improvement in the care that they provide.

Safety Climate Reflection and Learning
Structured Review of High Risk Patient Records
Enhanced SEA
GP Safe System Checklist
Criterion Audit and Care Bundles
Formative Peer Review System ( QI Projects including criterion and care bundle audits and SEA )
Always Events
Never Event's and Serious Patient Safety Incidents to inform guidance on Reporting and Learning System Engagement.

The Scottish School of Primary Care has produced a series of briefing papers on areas in quality and safety on which clusters could usefully focus their improvement activity[11]. Each paper summarises research, guidelines and other evidence about areas of care that can be improved, and improvement methods and interventions.

Over time, these will gradually be added to as GP clusters and others identify areas where they would find further briefings useful.

Initially, the areas covered will include:

Prescribing Safety
Chronic Pain
Managing Multimorbidity
Recognising and Managing Patients with "medically unexplained" physical symptoms
Partnership working with pharmacists
Improving management of long term conditions; the role of telehealth
Asthma
Care of refugees, asylum seekers and undocumented migrants
Mental health
Palliative and anticipatory care
Treatment burden

With the development of GP clusters and this style of working, comes also an opportunity to strengthen the role of general practice in epidemiological research. There is a close, synergistic relationship between clinical quality, clinical research and health system research, and potential to use this to improve the organisation of care and clinical outcomes. GP clusters offer a mechanism to encourage more of those with an interest in clinical academic practice to participate, and to improve the proportion of research funding in primary care.