Prof Niro Siriwardena spoke at the first engagement event of a new multi-organisational general practice quality improvement collaborative at the Stratford Olympic Park this February. The collaborative led by Professor Martin Marshall and his team at University College London, under the auspices of the Guttmann Academic Partnership launched in 2014, will involve working with NHS Newham Clinical Commissioning Group (CCG) and UCL Partners to support safer prescribing in Newham general practice.
Professor Siriwardena gave an introduction to quality improvement science approaches in his talk ‘How can QI methods in general help to solve these [safety] challenges?’ at the inaugural meeting together with other experts in collaboratives, including Prof Marshall and Dr Neil Houston from NHS Scotland, and local general practitioners. The talk was based on experience from regional and national quality improvement collaboratives such as the Resources for Effective Sleep Treatment project and the Ambulance Services cardiovascular Quality Initiative. Prof Siriwardena has recently been part of a team awarded funding from the Health Foundation for a new regional collaborative aimed at ‘Improving prescribing safety in general practices in the East Midlands through the PINCER intervention.’
The engagement event took place at the Sir Ludwig Guttman Health and Well Being Centre situated in the Olympic Park in Stratford, originally designed as the medical practice for the London 2012 Summer Olympics. It was well attended by general practitioners, patients and academic experts supporting the initiative and is part of the impact activity of CaHRU’s new research centre.
Professor Niro Siriwardena and the CaHRU team have been awarded a major grant from the Health Foundation under their Scaling Up Improvement programme. The project is led by Lincolnshire Community Health Services NHS Trust supported by the University of Lincoln, University of Nottingham, the East Midlands Academic Health Science Network and 17 of the region’s Clinical Commissioning Groups.
The aim of the study is to spread an intervention called PINCER (pharmacist-led information technology intervention for reducing clinically important errors in medication management) across East Midlands general practices and then more widely across the United Kingdom using a quality improvement collaborative, a model which CaHRU have used in previous projects.
The project will provide participating GP practices access to computer software that automatically reviews prescriptions together with expert support from a pharmacist who will work with practice staff to review prescriptions and drugs monitoring. This will reduce the risk of drug errors and failure to monitor, particularly in those people with more than one long term condition on a combination of drugs. Pharmacists and GPs will share learning as part of the project.
A new book, ‘Quality Improvement in Primary Care: the essential guide‘ has recently been published by Radcliffe. The book is co-authored by Dr Steve Gillam (Cambridge University) and Professor Niro Siriwardena (Director of CaHRU, University of Lincoln). The content was developed from the authors’ work on quality improvement over many years and on quality improvement and implementation science research conducted by CaHRU. The text provides the foundations of knowledge for health and social care practitioners and students to improve the quality of care they provide.
The first section of the book ‘Managing for quality’ leads readers though fundamentals of improvement including patient perspectives, leadership and management, regulation and commissioning. The middle section focuses on quality improvement tool and techniques covering topics such as improvement frameworks, processes, measurement, systems, safety, spreading improvement and financial incentives. The final part of the book covers evaluating improvement, understanding evidence and applying this learning to individual and group quality improvement projects.
Quality is a watchword across the health and social care sector. Quality Improvement in Primary Care will be a text for students embarking on the new course module, ‘Quality Improvement, Implementation and Safety Science’ which forms part of the new Master’s in Social Research at the University of Lincoln. It will provide readers with the tools to convert challenges and opportunities for improvement into meaningful and useful change.[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2014/10/Quality-improvement-in-primary-care.pdf” height=”1600″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]
Funded by the European Commission, awarding €62,000. Key contact: Coral Sirdifield.
The QUALICOPC study crosses over 30 European countries and aims to investigate which aspects of the structure and organisation of primary care are the most important in promoting service quality and equity while minimising costs. A team from CaHRU are running the UK section of this study. GP practices have been recruited from across the East Midlands and South Yorkshire region. Each practice was asked to complete a fieldworker questionnaire, a GP questionnaire, and questionnaires on patient values and experiences. Through this we hope to increase understanding of the variety of ways in which primary care is structured and organised in these regions, and to increase understanding of patients’ experiences of accessing primary care services and which aspects of care they particularly value.
A new study investigating how computerised cognitive behavioural therapy (CCBT) can be enhanced through the use of social networking platforms was published in the British Journal of General Practice in December 2012. This qualitative study, funded by the EPSRC and conducted by members of the CaHRU team, Jo Middlemass, Dr Zowie Davy and Professor Niroshan Siriwardena, explored patient and practitioner perspectives on CCBT programmes for insomnia (CCBT-I) which would included social networking.
The objectives of the interview study were:
To explore patient and professional perspectives, attitudes, expectations and beliefs towards online health care programmes;
To identify participants’ preferences for content, style and information disclosure to health professionals or fellow sufferers;
To investigate barriers and facilitators of access, use and adherence to CCBT with a focus on sleep problems and insomnia.
Two meta-themes emerged as key to enhancing uptake and adherence to a potential new CCBT-I package: the need for trust (in the programme, in the patient-professional relationship and in online peer support) and the functionality of the CCBT-I package, with potential users expressing a preference for it to be interactive, individualised and easily navigable.
The findings from the interview study have been incorporated into a novel online CCBT-I package which is currently undergoing testing, designed by a team led by Professor Shaun Lawson who leads the Lincoln Institute of Social Computing (LiSC) with co-investigator Dr Conor Linehan, both based in the School of Computer Science, University of Lincoln.
The study was published in the Br J Gen Pract December 2012; 62 (605): 642-643 with the full-length article available through open access: Middlemass J, Davy Z, Cavanagh K, Linehan C, Morgan K, Lawson S, Siriwardena AN. Integrating online communities and social networks with computerised treatment for insomnia: a qualitative study of service user and primary health care professional perspectives. Br J Gen Pract 2012; 62:e840-e850 doi: 10.3399/bjgp12X659321.