Chronic Disease Management Quality Planning

In July, our team presented a report to the GP subcommittee looking at Chronic Disease Management (CDM) and primary care remobilisation. The report is structured by a quality planning perspective.

The report was submitted to the GP subcommittee and has since been distributed to Cluster Quality Leads (CQLs) and practice managers. Click the image on the right to view the executive summary. Alternatively, a copy of the executive summary can be found here.

If you are interested in reading the full report, please contact the team.

This recent editorial in the British Medical Journal -

BMJ 2020;371 doi:https://doi.org/10.1136/bmj.m3793 (Published 05 October 2020) - mirrors many of the issues raised and recommendations made in the Lothian CDM planning report, and also recognises that “any changes should aim to maximise the capacity and effectiveness of primary care but must also ensure that health inequalities are narrowed not widened, such as the ethnic disparities in infection and mortality seen with covid-19”.

They also identify key areas including the effective use of telehealth and video consulting, appropriate interface working, good anticipatory care planning, and the wider use of the multidisciplinary care team as areas that need further exploration and testing

National Scale Up BP

The Lothian Scale UP BP project is underway with support available to practices wishing to begin improvement in this area.

A helpful resource package can be downloaded here (PDF) (Word). More information can be found at TEC Scotland

Practices are encouraged to contact the project team for more information. Practices are welcome to consider this area of work for their enhanced service project.

Healthcare Improvement Scotland - Practice Administrative Staff Collaborative

The ihub have created digital and physical resources for practices to support the roll out of workflow optimisation and care navigation work. Practices should have been sent physical toolkits. Digital versions of the toolkits can be found through the ihub website here.

The QI team are able to provide support with these toolkits for Lothian practices interested in the work. Contact us here.

Measuring changes in GP workload guidance

The Lothian Primary Care Data Group has developed guidance to support practices with measuring change in GP workload when they introduce additional staff to the practice team, e.g. an AHP or Practice Mental Health Nurse.

It is important to note there is variation in the way GPs record consultation data, which can make measurement of GP workload difficult. Appendix 1 contains a guide for recording consultation data in Vision which was developed in conjunction with a GP and has been piloted by a GP Cluster.  

Please note that this guidance was developed to help practices measure a change in workload. It is not guidance for a complete evaluation of the role of AHPs or Practice Mental Health Nurses in Primary Care as there may well be other benefits to their role that are not captured by this analysis.

Download here

Please email Analysts.PrimaryCare@nhslothian.scot.nhs.uk in the first instance if you have any queries regarding this guidance.

Detect Cancer Early - Good Practice Guide for Primary Care

The Good Practice Guide is designed to make it easier for busy practices to make small changes to improve, with a focus on sustainability and working with what is already in practice, building on existing resources and skills. Giving you the tools and guidance on how to start small to make a big difference.

This guide has been developed by the DCE team taking the learning from work done in primary care. By collating all of the “quick win” initiatives and tests of change that demonstrate best practice in engaging with vulnerable populations, the guide aims to facilitate and embed good practice across Lothian.

Feedback from everyone who uses it is welcome and vital in order to maintain its relevance and optimise the benefits that it can bring to General Practice. The DCE team will update the document in response to practitioners’ feedback, add new initiatives and share best practice to support quality improvement.

Find here

A GP toolkit and checklist has been produced by Healthcare Improvement Scotland’s ihub in collaboration with Amzheimer Scotland. This can be accessed by clicking here.

A framework for supporting QI work in improving diagnosis and post-diagnostic support can be found by clicking here.

Referral to hospital - Leaflet guide

Reducing demand for GP appointments

Midlothian GPs in conjunction with the Lothian Interface Group have developed a leaflet guide for patients being referred to hospital to help to explain what to expect.

The leaflet will aid to effective communication by answering the following questions:

1)What are the Benefits

2) What are the Risks

3) What are the Alternatives

4) What if I do Nothing

The letter can be personalised with the relevant HSCP logos for use in your own practice by clicking here.

Recent work at Teviot Medical Practice in the Borders has seen up to a 5.5% reduction in all routine calls to reception and a 21% reduction in the routine GP appointment waiting time.

This work has recently been published and is available by clicking here.

Social Prescribing

St Triduana’s in Edinburgh have kindly shared social prescribing information documents. Click on the titles to download.

Useful Websites

Please feel free to email us if you have any suggestions for addition.

Kings Fund – English charity that shapes health and social care practice

ihub – Scottish resource supporting health and social care

IHI – institute for healthcare improvement – international US based organisation seeks to improve and health care world wide

The Health Foundation – UK charity supporting better health and health care for the UK http://www.health.org.uk/?gclid=CNTrs63snNQCFcIK0wodGQ0HtA

RCGP Quality Improvement - http://www.rcgp.org.uk/clinical-and-research/our-programmes/quality-improvement.aspx

East London Foundation Trust Quality Improvement Network - https://qi.elft.nhs.uk/