Key themes emerging from general practice quality improvement initiatives to help tackle clinical capacity and patient access
General practice continues to face significant challenges in the wake of the Covid pandemic. Despite efforts to increase appointment availability, patients still report frustration when trying to access GP services, and many practice staff are at risk of burnout due to overwhelming workloads. These challenges are particularly pressing, as patients increasingly seek the timely, compassionate care they have come to expect, while practices struggle to meet demand.
The need to tackle these pressures is recognised in the Modern General Practice model, which aims to better align capacity with demand, improve the working environment for staff and improve patient experience. Implementation of the model has been supported by quality improvement initiatives such as the General Practice Improvement Programme (GPIP) – Practice Level Support (PLS), providing hands-on support to practices wanting to explore and implement opportunities to improve productivity, patient outcomes and staff wellbeing. We have worked collaboratively across NHS Arden and GEM, Midlands and Lancashire, North of England, and South, Central and West CSUs as one of five PLS Delivery Partners. From our experience of supporting practices the following six themes have emerged which could help other practices identify opportunities to improve.
Optimising appointment allocation for better patient access: Making sure patients see the most appropriate person for their needs impacts both patient access and clinical capacity and is one of the strongest themes that has emerged. Practices, including those that have previously worked on clinical triage, are typically finding approximately 30% of GP appointments could be seen by other clinicians within the practice, primary care network (PCN) or beyond. Collating and analysing meaningful data enables patients to be signposted to the clinician best placed to support them, either within the practice or to other services based on clinical need, thereby reducing the burden on GPs.
With support from our facilitator, South Wigston Health Centre, Leicestershire, has developed its own care navigation tool to tackle inappropriate appointments, written by the practice’s GPs. Based on how patients present and respond to bespoke questions about symptoms, patients are directed to appropriate services, or the wider primary care team and urgent and routine appointment needs are differentiated. Since implementation, up to 40% of patients are now seeing practice specialists rather than immediately seeing GPs, releasing time for patients with more complex illness and needs.
Embedding proactive care for frequent attenders: Frequent attenders often have complex needs that require a more structured approach to ensure they receive the right support while optimising general practice capacity. A frequent attender is defined as a patient with significantly more consultations than average, often considered to be ten or more GP appointments per year or 20+ contacts across various primary care services. Some quality improvement initiatives focus on patients with 30+ or 50+ appointments annually, particularly those who could benefit from proactive management. Practices can vary the threshold they use based on size, patient demographics and local healthcare demand.
Quality improvement initiatives help practices analyse appointment trends and clinical histories to identify common patterns and a multidisciplinary approach enables patients to be directed to the most appropriate clinician or service, reducing unnecessary GP appointments. Embedding continuous improvement through Plan Do Study Act (PDSA) cycles allows practices to track trends, evaluate interventions and refine approaches. By shifting from a reactive to a proactive model of care, practices can better support frequent attenders while optimising clinical capacity and reducing unnecessary demand.
Standardising processes to improve efficiency and quality: Practices may have good workflows in place which most people follow but if that approach isn’t common to everyone, it can mean others have to adapt their workflows to suit different individuals. This creates inefficiencies and can even lead to quality or safety issues. Identifying and tackling these clinical or administrative variations will enable a practice to embed consistent, repeatable processes that save time and enhance quality.
Streamlining roles to enhance practice efficiency and staff satisfaction: Clear and defined job standards are crucial not only for improving operational efficiency but also for enhancing staff wellbeing. When team members have a clear understanding of their roles and responsibilities, it reduces confusion, prevents task duplication and helps identify areas where workloads can be better distributed. This clarity fosters a sense of ownership and accountability, which in turn contributes to greater job satisfaction and reduced stress. By clarifying job standards, practices can create an environment where staff feel more supported, engaged and confident in their work. This leads to a reduction in burnout and a more resilient, productive team overall.
Predicting and preparing for patient demand: One of the major challenges in overcoming the so-called ‘8am rush’ is in not knowing what to expect. Using retrospective data, often from cloud based telephony systems, can help practices profile expected demand and match capacity based on intelligence about the needs of the population. Using telephony data to identify peak demand by time and day and establishing the bottlenecks where abandoned call numbers are high can inform revisions in schedules and rotas to support the incoming demand.
Mapping workflows to identify improvement opportunities: Mapping processes has proven to be enlightening for many of the supported practices and is a tool used frequently. This technique can be applied to any type of workflow and supports teams to understand how different processes interrelate and highlight opportunities for improvement. As a quality improvement tool, regularly reviewing and reassessing workflows and working methods can help practices adopt continuous improvement approaches in response to changing requirements.
Chillington Health Centre in south Devon, has used process mapping to understand delays in processing referrals. Having identified that secretaries were having to go back to GPs to request additional details, the team has developed an automated process which prompts clinicians at the outset for every bit of information they will need for each referral. Since implementation, medical secretaries have saved approximately 1-2 hours every week, with quicker referrals also supporting better patient care.
Commitment today for resilience tomorrow
Any quality improvement activity requires time input to reap the full benefits. This can often prove a barrier to take-up as many practices are already overstretched. But in our experience, the short-term pain of that time investment is proving to pay back quickly by enabling practices to overcome persistent challenges, implement new ways of working and provide a more responsive service to patients.
In delivering support to practices, we encourage them to commit to a series of weekly sessions. Chillington Practice Manager, Jade Greet, admits this was a challenge initially but has proved rewarding, particularly in breaking down internal silos and strengthening workplace satisfaction. “The immediate benefits aren’t always clear to staff as it can feel like additional workload, but carving out three to four hours each week has made it really beneficial. It’s helped bring the team together and we’ve been able to deliver quite a lot of quick wins.”
By committing to structured quality improvement programmes, practices not only enhance their immediate capacity to meet patient need but also lay the groundwork for a more sustainable, resilient healthcare system in the future. The commitment of time and effort today ensures better patient care and stronger teams tomorrow.
By Alison Westmacott, director of primary care, NHS South, Central and West CSU and Ian Razzell, associate director of primary care, NHS Arden and GEM CSU on behalf of the Commissioning Support Unit Collaboration
