Practice brief

Fast, practical improvement

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General Practice Improvement Programme

practice brief

Practice Brief

This short brief will show you how the General Practice Improvement Programme (GPIP) works and how to get the most out of it for your practice.

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The pe

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How th Progra

Prov with impr

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ward downham improvement design

A joint development by KM&T and wdid

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The General Practice Improvement Programme (GPIP) provides fast, practical, practice improvement to help reduce pressures and release efficiencies within general practice.

Working through 5 high impact areas, and following a ‘Teach, Simulate, Do’ philosophy, practice staff are empowered to make real and lasting change that benefits both patients and practice staff.

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The perfect storm facing general practice We believe general practice is facing a perfect storm.

Practices tell us they are under pressure from: • An ageing population, resulting in increased activity per patient.

• Increasing prevalence of lifestyle related illnesses, resulting in more complex patients and more activity per patient.

• Increasing demands from patients both in terms of quality of care and of response time for services offered.

• Increasing scrutiny from central and regulatory bodies which takes up more time from GPs and other practice staff.

• Increasing running costs against fairly static funding arrangements.

We understand that in general practice this pressure gets personal very quickly with practice staff of all types feeling a huge amount of personal pressure and resulting stress.

How the General Practice Improvement Programme (GPIP) helps

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Benefits for practices GPIP has been specifically designed by primary care improvement experts to address CCG and Practice needs. Practices across urban as well as rural settings have already seen significant results.

Savings Testing has indicated that practices can harness substantial productivity gains with the General Practice Improvement Programme • Testing has shown practices releasing up to 10 hours per week of GP consultation time • Potential list size increase by 1150 patients • Generated an additional 75k in revenue

Better run/higher performing

Systematic approach to improving our practice

Check the GPIP website (www.gpip.co.uk) for latest case studies on benefits and experiences from practices getting support through GPIP. 5

Benefits for Clinical Commissioning Groups (CCGs) and other regional stakeholders: GPIP provides CCGs and GPAs (General Practice Associations) with a cost effective and practical mechanism to: • Engage and support your practice with improvement methods which enable you to cope with current and future pressures.

• Further demonstrate value to your practice members and engage busy front line GPs. GPs are now central to both the primary and secondary healthcare commissioning and improvement agenda. To move beyond small scale, and sometimes token, engagement, CCGs need to demonstrate value to their members. This means helping their GP members with the problems they face on a daily basis.

GPIP is ideally placed to enable your CCG to do that.

The Kings Fund on the need CCGs to engage with general practice

“ If the disparity grows wider over time, CCGs risk losing their connection with grassroots GPs and repeating the history of diminishing clinical involvement characterised by many primary care trusts.”

Kings Fund, Clinical Commissioning Groups (regional care commissioning organisation) – Supporting Improvement in General Practice 2013

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Prove you can improve Practices have said that they need help before starting their improvement journey, and that they need to build confidence and capability as they begin to start a long-term plan of improvement to meet the pressures they face.

The work areas of GPIP have been carefully chosen not only to make immediately applicable and high impact improvement, but also to help your practice learn best practice operations management and improvement. This is so that as a practice, you can continue on your journey without the need for support.

How it works GPIP consists of a number of Practice based sessions (minimum 12) over a three month period. These short visits (after all, practice staff still have the day job to do!) are made by improvement experts and cover five main work areas.

The on‑site support visits are practical and focused on making changes and improvements there an then – no homework. Each short visit is structured around the GPIP Brief, Simulate, Do cycle.

There are five main areas based on best practice techniques from healthcare and other sectors such as industry. Many are sourced from Lean thinking.

Our on‑site support is also complemented by high quality workbooks for each work area (see page 8 and 9). You will receive your workbooks as soon as you have confirmed your participation in GPIP. The final element of support for your practice is provided via our telephone helpline. For a period of one year after you commence GPIP you have access to the GPIP helpline where an expert in the techniques behind GPIP will be able to help you with any queries you may have as you carry on your GPIP journey.

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Main work areas The five main work areas per practice (subject to co‑production discussions – see page 10) are: General Practice Improvement Programme Fast, practical improvement

chasing the tail

Chasing the tail Training in a structured MDT meeting format (and data collection) that uses a structured problem solving approach to identify interventions for high volume users or ‘frequent flyers’. These meetings, held bi‑weekly, help you to release capacity.

ward downham improvement design

A joint development by KM&T and wdid

General Practice Improvement Programme Fast, practical improvement

workplace organisation ward downham improvement design

A joint development by KM&T and wdid

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Workplace organisation Using workplace organisation techniques such as 5S, transform your reception and back office areas using visual management techniques.

General Practice Improvement Programme Fast, practical improvement

workforce planning

Workforce planning The use of pragmatic planning techniques ensures the correct planning of your staff at year, month and day level.

ward downham improvement design

A joint development by KM&T and wdid

General Practice Improvement Programme Fast, practical improvement

effective emails & meetings management

Effective emails & meetings management Introduction of structured techniques for individuals (email management) and teams (meetings management) helps ensure your time is not wasted and your communication is clear.

ward downham improvement design

A joint development by KM&T and wdid

General Practice Improvement Programme Fast, practical improvement

consistency of approach

Consistency of approach For high volume conditions, facilitating discussion and decision making between clinicians in your practice, enables you to form common approaches, so reducing (but not absolutely removing) variation between clinicians.

ward downham improvement design

A joint development by KM&T and wdid

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Workbooks To support knowledge transfer and building of capability within practice teams, workbooks in each of the work areas are also supplied to you. These high quality workbooks provide supplementary and supporting guidance to complement the support provided by the expert GPIP facilitator during your visits.

This allows you not only to explore the techniques in more detail, but also helps you to ensure knowledge transfer for your practice. So when the GPIP team finish the support to your practice, you will still have a wealth of improvement guidance available to you.

In addition to the workbooks you will also be given a personal login to the GPIP website. This gives you access to further GPIP materials.

Co-production While we have used our great depth of experience in general practice to create a set of hard‑hitting interventions, we also believe that only practices themselves can define the exact improvements undertaken.

This is because understanding of the local context is vital.

As part of GPIP we undertake co‑production sessions with practices and other stakeholders to understand the exact local context and co‑produce an exact format of interventions. This means that as a practice you ‘own’ the process, rather than it being ‘done to’ you.

As a CCG, you can also be sure that your operating and strategic plans are carefully mapped against the practice level improvements so that all the relevant connections are made.

If you are accessing GPIP through your CCG then they will be getting in touch to arrange your co‑producion session. If you are accessing GPIP directly then your GPIP facilitator will be arranging the session with you.

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What ofpractice practice GPIP suitable Whattypes type of is is GPIP suitable for?for?

Consideryour yourpractice practice against below.

GPIP is definitely for Consider againstthe thematrix matrix below.

GPIP is definitely if the statements of one of the quarters describes foryou you if the statements of one oftop thetwo top(green) two (green) quarters your practice. If you are in the amber quarter, then we can help with describes your practice.

If youalso areget in the amber quarter, then we can your considerations so please in touch. help with your considerations so please also get in touch.

Which yourpractice? practice?

Whichstatement statement matches matches your

✔✔ ✖

We deliver now, have strong drive and ambitious future plans...

We are striving to improve...

We have just been told we need to do this/it seemed like a good idea…

We are interested in this improvement ‘stuff’ and willing to put some serious time into it…

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What is this all based on?

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As mentioned previously, the team behind GPIP were also part of the team behind NHS Improving Quality’s Productive General GPIP ‘bolt ons’ Practice programme. In addition the team behind GPIP have all worked either within NHS or areas, for theyour NHSpractice for many years, By working through thethe GPIP work will be building providing expert improvement guidance many different the capability and confidence to tackle more for improvement areas. health and social care settings.

At a time when you feel your practice is at this point, GPIP offers you optional additional expertise in the form of work area bolt ons. These new work areas cover challenges that Our coretell themes techniques stem from best practice operations management practices us areand further high priorities.

and Lean techniques. These techniques, often from other sectors, have been Check the website and (www.gpip.co.uk) the range of existing and planned boltensure ons. proved in GPIP healthcare, provide hugeforbenefit to organisations.

They help clinicians and social care professionals are unhindered in their work with patients and service users, whilst making use of safe and efficient processes.

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The differencebetween betweenGPIP GPIP and The difference and Productive General Practice (PGP) Productive General Practice Many practices ask about the differences between GPIP and PGP. While PGP is a strong programme in its own right, GPIP has been designed using the learning from PGP (many of the GPIP team worked on the design team for PGP). This makes GPIP faster, more practical, harder hitting and simpler than PGP. Comparison table between GPIP and PGP GPIP

PGP

Timeline:

3 months

18 – 36 months

Scope:

Immediately applicable improvements dealing with everyday problems

Long term strategic view

Support:

12 visits to practice

4 visits to practice

Support Style:

Hands on in practice support to help deliver improvement

Overview of modules

Co-Production:

Yes – personalise to your exact context No Yes No

Bolt Ons / Additional Areas Available:

Created through Yes experiences with practices

Yes

GPIP and PGP are not in competition: Ultimately, GPIP and PGP are not in competition. It is not really a choice between them.

For the majority of practices the pressures of the here and now are all consuming and they need fast, practical improvement support. In this way, GPIP can be seen as an enabler for PGP. Building capability and confidence through GPIP so a practice can consider other more complex improvements such as PGP or other GPIP ‘bolt ons’.

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What GPIP GPIPbrings bringsand andwhat what you need to What you need to commit commit GPIP gives you:

What you as a practice need to commit:

Expert improvement support across five work areas.

Staff for each visit as detailed in your visit schedule.

Expert GPIP facilitator who will respect your practice and conform to your policies and procedures.

An open mind to the methods and challenges to current ways for working.

Access to world-class improvement expertise.

Help create an open ‘improvement environment’ where your staff can talk openly about challenges and opportunities.

Passion and enthusiasm to improve your practice. Ensuring one eye on how to continue your improvement journey long term.

“ In a busy place like surgeries “In a busy place like surgeries are, I think it has improved are, I think it hasand improved communications working communications and working relationships and relationships and understanding understandingof what each other does, particularly of what each other does, between upstairs and upstairs downstairs.” particularly between and downstairs”.

GP Partner GP Partner

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Points to think about and set up succeed Urgency From our experience, one of the hardest types of practice to get improvements in is one that is comfortable. Change is difficult and requires a certain amount of urgency to make it happen. Your GPIP expert facilitator will work with you to detail the urgency for change your practice faces, thus ensuring that together we build that message into the improvements we do.

Constant input Your GPIP expert facilitator will talk to you about what controls you will put in place ready for the time after the on site GPIP support finishes. All change relies on constant input to make sure it sticks. This does not have to be too onerous and is something for which we will together make sure your practice is well prepared.

Roles and responsibilities within your practice Practice champion • Generally the practice manager.

• Responsible for local project management of GPIP. • Keeping project momentum.

• Making the links with other work.

Work area leader • Normally a different leader for each work area.

• Organises the particular work associated with a particular GPIP work area.

• Will become expert in the work area and then spread the methods to other areas of the practice.

Practice staff in general • All staff to participate in at least one of the sessions related to the five main work areas.

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out of it for your practice.

ward downham improvement design

A joint development by KM&T and wdid

GPIP is a joint venture between KM&T and wdid KM&T and wdid are the perfect match for developing high quality improvement programmes and campaigns.

KM&T (Knowledge Management and Transfer) offer a track record of supporting national improvement programmes for the NHS, expertise in large-scale mobilisation, considerable resource and a high level of technical improvement expertise. www.kmandt.com

ward downham improvement design

wdid (Ward Downham Improvement Design) offer local and national improvement programme development and leadership expertise. They are the team behind many of the most successful improvement programmes ever seen in the public sector. www.wdid.co.uk

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For more information on GPIP: Website: www.gpip.co.uk Telephone: +44 (0) 247 623 6275 Email: info@gpip.co.uk GPIP Support Line (for practices implementing GPIP): Telephone: +44 (0) 247 623 6275 Postal Address: GPIP Team KM&T Ltd The Techno Centre Puma Way Coventry CV1 2TT ©Copyright Knowledge Management and Transfer Ltd/ Ward Downham Improvement Design Ltd 2014 – All Rights Reserved

www.gpip.co.uk 16