Background and Aims
The Enhanced Primary Care Development Programme (EPCDP) set out to develop service improvement capability in eight general practices (Cohort 1) in Dudley Primary Care. It was intended that through supported service improvements, each practice would not only develop capability for change but also enhance practice efficiency and release capacity with the ultimate goal of improving services for patients.
The EPCDP had a precedent in a pilot project delivered by the Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit. This bespoke project at a single Dudley general practice had focused on efficiency and change management and delivered service improvements (Mulla et al 2014). Following the positive feedback from the pilot, Dudley CCG and the Strategy Unit collaborated to develop a programme for enhancing primary care development in Dudley based on the principles of the pilot which was then called EPCDP.
Most practices were able to demonstrate achievement of objectives of their service improvements in at least two of their chosen focus areas. All practices found the structured approach to change useful; the lengthy time spent in the early stages due to engagement and consultation activities was rewarded by the comprehensive yet targeted improvement undertaken. Some practices used the structured approach learnt to tackle other areas of interest to the practice and understood that even with planned changes, this was the beginning of a cycle which required maintenance.
The EPCDP was delivered through four joint learning sessions, ranging from 0.5-2 days each with attendance from all Cohort 1 practice leads (usually a GP and Practice Manager), relevant EPCDP project team members and Patient Participation Group representative(s) if available. The second component of the programme was the in-house support by a delivery lead through the course of the programme, which accounted for 20 days of the delivery lead in half day sessions over six months. The capacity to deliver the programme at individual practices was funded by way of backfill or overtime as relevant to participation. The evaluation of the EPCDP was largely a qualitative research approach with each practice constituting a case study. Focus groups (n=16) were held with practice project teams before and after the programme delivery to ascertain the experience and progress through the programme at each practice. Thematic analysis was undertaken of the focus group transcripts following an inductive approach and made use of previously identified general practice ‘culture’ domains. Practices also engaged in staff and patient surveys and relevant service improvement data collections. Findings from each contributed to providing the rich descriptions of the case studies.
The EPCDP facilitated organisational development and through it effective service improvement activities that resulted in enhanced practice efficiencies. The programme delivery specifically contributed to the emergence of medical leadership, enhanced communication and improvements in staff experiences.
- The funding to participate provided the protected time to engage in the programme and this dedicated time was critical to the delivery of change efforts.
- As a result of the EPCDP, most practices developed some capability for change, introduced efficient processes which could release capacity, and improved services received by patients.
- Overall, a range of progress was exhibited by practices in the context of service improvement. Practices that were able to mobilise quickly and effectively were more experienced or had prior awareness of service improvements.
- The enhanced capability of GPs to lead on delivering change at their practice was a key success of EPCDP. The different GP leads enacted their role differently, sometimes constrained by capacity or capability of their staff, and sometimes facilitated by engagement and involvement of their medical colleagues.
The findings and positive feedback of Cohort 1 practices supported further development of the programme such that Dudley primary care is in a position to deliver their multispecialty community provider vanguard. The evolved three tiered programme is renamed ‘Enabling Practices to Improve and Change’ (EPIC) with components of business management, service improvement and transformation. EPIC started in mid June 2016 and will be subject to a further research and evaluation and is expected to have transferable lessons for wider primary care in light of General Practice Forward View.