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Quality Improvement Initiative of the Year - HSJ
Improving Patient Safety through better Access to Appropriate Professionals in Primary Care: a whole system approach
The Improvement Team at West Quay Medical Centre (WQMC) came together during this nine-month project, to focus on an area of service delivery that our Patient Participation Group (PPG) had identified as an area for improvement.
A baseline PPG survey established that 95% of patients considered their care to be good or very good, but that 54% had experienced difficulty in obtaining an appointment
Working in co-production with the PPG was a key feature of the Access Project. A PPG representative was present during our weekly Quality Improvement meetings, and fed back to the wider patient group.
The three main drivers were:
- Changing the cultural norm of “G.P first” for an appointment request.
- Redesigning the Appointment System
- Reducing unwarranted variation & waste in the system
The team considered that patient safety could be improved if we adopted the Principles of Prudent Healthcare more fully, and in particular, ensured equity of access & caring for those with the greatest health need first.
We took a systems approach to patient access, improving patient safety over 75 PDSA cycles of iterative change, all, within existing resources.
The outcomes included:
- An increase in core clinical capacity of 5% and including an increase in allied Healthcare Professionals (AHPs) a total of 9.6% total appointment capacity.
- Improvements in medication safety included an eight-fold increase in the number of bespoke medication optimisation reviews with a clinical pharmacist, radical changes to the repeat prescribing system designed to reduce waste and medication errors, and a focus on high risk medication, such as opiods, resulting in a downward trend of overall prescribing in this drug category.
- Holistic assessments for very frequent attender patients identified unmet needs, and improved their care whilst also increasing the interval between subsequent appointments, in an example of improvements both for an individual and for the larger patient cohort.
- And others beyond the scope of this summary.
We found that public understanding of the different roles of all the AHPs in the team was poor, and that raising awareness of the skills of all team members reduced unfilled appointments, and enabled GPs to concentrate more on patients with complex needs.
The culture at WQMC is such that GP Partners and senior management prioritise resources for QI, and the sustainability of this culture is preserved through home-grown QI expertise. Front-line ideas drove the access project, and in addition to the Patient Group, our receptionists were key members of the Improvement Team.
The focus on patients as equal partners in co-design of services, use of front-line staff improvement ideas, and small tests of change added real quality to the project, and improved patient access as well as staff engagement at a time of increasing workload in Primary Care.