1. HEALTH & SOCIAL CARE GATHERING Delivering Quality Improvement
Dr Gordon Black
Zaid Tariq
Emma Cumming

2. Workshop Plan
Aims:
To raise awareness of current Cluster working arrangements, understand some of the support for Clusters and how to become more involved.
Objectives:
The workshop will give delegates the opportunity to:
Learn more about what quality improvement support is available;
Learn from those with first-hand experience in developing quality improvement plans
Share experiences and learning from both successes and challenges in implementing changes.

3. Where have Clusters come from?

4. Why we need to change the world is changing
Demographics
Health and Social Care integration – the new world
keeping people in the community is right thing to do
Staying at home or homely setting is what people want
Investment in primary care is cost effective
the status quo is not sustainable
The system is under growing pressure – GP workload, in hours / OOH
All professions are keen to operate to the top of their professional capabilities
Health inequalities demand creative responses
No need for me to go into detail here but important to recognise as Dr Gordon Black did earlier with his perspective from the front line the challenges that we face.

6. Changes to GMS Contract
The Scottish Government and BMA Scotland have agreed to develop a Scottish GP contract aligned with the Scottish Government’s 2020 Vision of health and social care

7. GP Contract 2016/17
QOF dismantled from 1 April 2016
Transitional Quality Arrangements
‘..each GP practice will engage in a local Cluster group…..’
‘…we anticipate that each and every GP will have a role in Continuous Quality Improvement within the practice…the CQLs will have a mandate to improve quality in the wider health & social care system….’

8. Changes from 2016
‘Removal of QoF’ – development of Transitional Quality Arrangements (TQA)
Stage 1 Q1 ( )
PQLs appointed; clusters agreed; start to consider quality issues
Stage 2 Q2 ( )
CQLs agreed and appointed; continue to consider quality issues
Stage 3 Q3 ( )
PQLs and CQLs build relationships within cluster and between cluster and local systems; agree which issues to take action on in stage 4
Stage 4 Q4 ( – )
Practices and system take action on priorities agreed in stage 3

9. Role Of GP Clusters
Improving Together: A National Framework for Quality and GP Clusters in Scotland set out the intrinsic and extrinsic functions of clusters as follows:
Intrinsic
Extrinsic
Learning network, local solutions, peer support
Collaboration and practise systems working with Community MDT and third sector partners
Consider clinical priorities for collective population
Influence priorities and strategic plans of Integrated Joint Boards
Transparent use of data, techniques and tools to drive quality improvement – will, ideas, execution
Provide critical opinion to aid transparency and oversight of managed services
Improve wellbeing, health and reduce health inequalities
Ensure relentless focus on improving clinical outcomes and addressing health inequalities

10. Transforming primary care
“new world”
transition
performance
“old world”
From a prescriptive contract to an enabling contract…
In 2017, a new GP contract will be introduced in Scotland. The origins of this began in late 2012, when UK GP contract negotiations broke down and for the first time changes to the contract were agreed that began to differentiate the approach taken in the four UK countries.
I view this next stage as a time of transition to the “new world” where the importance is on getting the foundations for the future right.
now
2017
2020
time

11. So what have we done so far?

12. Peer Led, Values Driven, Quality Process
GP Clusters - common purpose
Practice Quality Leads – protected time
Cluster Quality Leads – boundary spanners
QI tools
Evidence base simply presented
Analytics
Continuous professional development

13. Collaborative Quality Improvement in General Practice Clusters (SSPC GP Cluster Briefing Paper No. 12)
…to function effectively and contribute to local Quality Improvement, GP Clusters in Scotland will need the following:
An understanding of the principles and practice of Quality Improvement
Local autonomy to determine what topics/ clinical areas to address
Local GP leadership and buy in from the clinical community
Support to develop and use facilitation skills to enable the cluster to form and develop
Easy access to relevant local and national data
Administrative support and engagement with the health and social care partnership

14. Healthcare Improvement Scotland
Our role in one sentence.....
Supporting health and social care services to redesign and continuously improve
Title slide option 1

15. Our Primary Care Support
Quality Improvement Programme Support
Development of Quality Improvement and Leadership Skill
Development of a national learning system
GP Cluster Support
Review and analysis of Primary Care Transformation Fund and associated projects
Primary Care Transformation Fund
Including Continued support of SPSP workstreams (dentistry, sepsis, pressure ulcers and general medical services)
Management and support of a Rapid Improvement Support Fund Primary Care to inform locality planning and system redesign

16. GP Cluster Support Quality Improvement Programme Support
Appointment of IA and AIA to engage with and support Cluster working
Development of a series of ‘commissions’
Development of Quality Improvement and Leadership Skill
Working with NES (scoping exercise)
Development of a national learning system

17. Role Of GP Clusters
Improving Together: A National Framework for Quality and GP Clusters in Scotland set out the intrinsic and extrinsic functions of clusters as follows:
Intrinsic
Extrinsic
Learning network, local solutions, peer support
Collaboration and practise systems working with Community MDT and third sector partners
Consider clinical priorities for collective population
Influence priorities and strategic plans of Integrated Joint Boards
Transparent use of data, techniques and tools to drive quality improvement – will, ideas, execution
Provide critical opinion to aid transparency and oversight of managed services
Improve wellbeing, health and reduce health inequalities
Ensure relentless focus on improving clinical outcomes and addressing health inequalities

18. ‘Consider clinical priorities for collective population’
How are clusters doing this and how might we help?
In collaboration with ISD LIST analysts:
Cluster Population Health Needs Assessment
Develop Cluster Quality Improvement Plan
Support implementation of Quality Improvement Plan
Using QI methods implement changes (action planning, monitoring and evaluation)
Support continuous quality improvement (learning, measuring impact, identifying next priority)
Capture learning, share tools resources for national use.

19. Our approach to developing a National Learning System
Shared Learning
Networks
Knowledge Management
Local /
National
Collaboration
Collaboration – working in partnership with other national organisations and stakeholders
Shared learning – capture and theme primary care improvement activity, across clusters from list teamand A3 reports from PCTF
Networking – support peer to peer learning and develop networks, CQLs and H&SCPs Leads and MDT members PMs, etc.
Knowledge Management – develop online tools and resources to support quality improvement activities
Implementation work with the primary care evidence collaborative to develop evidence base to support spread and national implementation
Implementation at Scale

20. LIST : Supporting Primary Care and GP Cluster information needs across Scotland
Met with 82 of the 143 Clusters to date (57%) some areas of interest identified have included:
• Diabetes and prevalence / number of foot screening for diabetics
• Home Visits
• Demand and Capacity (housing developments)
• ACPs, Frailty and Risk prediction
• Chronic Pain Management
• Appointments, Impact of Pharmacy, Benchmarking and Variation

21. Emma Cumming Inverclyde HSCP

22. Benefits & Challenges of GP Cluster working
Consider –
Do you know your local CQLs / Clusters?
What experience have you had with GP Clusters?
What benefits have Clusters made?
What challenges are there in Cluster working?
Ask to write on paper table clothes using colour guide above.

23. Benefits & Challenges of GP Cluster working
Consider –
What do you think are priorities for Cluster working?
Considering the Extrinsic function in particular?
What additional support / help do you think Clusters could have?
Ask to write on paper table clothes using colour guide above.

24. Benefits & Challenges of GP Cluster working
We are trying to develop a National learning network – would you like to be part of it?
Would you be willing to leave contact details?
Ask to write on paper table clothes using colour guide above.

25. What else can/
should we be doing?

26. Thank you
Questions/Discussion