Online services in general practice: patterns of use and barriers to uptake

Online services in general practice: patterns of use and barriers to uptake
PHE 30 September 2021

• The aims of the project were to achieve a better understanding of the needs of segments of the population through:
• reviewing the evidence relating to the effectiveness of online services to support general practice
• using the Mosaic Public Sector Tool to segment the Surrey Heath CCG population according to their use of online services, thereby identifying groups that are more and less likely to use these services
• analysing the use of online services by the Surrey Heath CCG population to identify any associations between patterns in usage and demographic factors
• conducting insight gathering work to explore barriers and enablers to the use of GP online services

CVDPREVENT - primary care audit

CVDPREVENT
NHS England

• CVDPREVENT is a regular national primary care audit making it easier for practices to systematically identify people whose treatment could be improved, and risk reduced. It will automatically extract routinely held GP data covering diagnosis and management of six high risk conditions that cause stroke, heart attack and dementia: atrial fibrillation, high blood pressure, high cholesterol, diabetes, non-diabetic hyperglycaemia and chronic kidney disease. It will support primary care in understanding how many patients with the high-risk conditions are potentially undiagnosed, under treated or over treated. 
• Find out more  on the NHS Benchmarking platform including a quick guide and key dates

Quality improvement in general practice: what do GPs and practice managers think?

Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers
BMJ Open Quality 2021;10:e001309. doi: 10.1136/bmjoq-2020-001309

• Results of the first UK-wide survey of NHS GPs (n=2377) and practice managers (n=1424) designed to explore the service improvement activities being undertaken in practices, and the factors that facilitated or obstructed that work. Ninety-nine per cent reported having planned or undertaken improvement activities in the previous 12 months. 
• The most frequent related to prescribing and access. Key facilitators of improvement included ‘good clinical leadership’. The two main barriers were ‘too many demands from external stakeholders’ and a lack of protected time. Audit and significant event audit were the most common improvement tools used, but respondents were interested in training on other quality improvement tools.

General Practice Data for Planning and Research (GPDPR)

General Practice Data for Planning and Research (GPDPR)
NHS Digital 14 May 2021

• A new way to collect GP patient medical records which supersedes the General Practice Extraction Service (GPES). In addition to replacing what GPES already does, the General Practice Data for Planning and Research service will also help to support the planning and commissioning of health and care services, the development of health and care policy, public health monitoring and interventions (including coronavirus and enable many different areas of research. This data will be shared from 1 July 2021.

RCGP Health Inequalities Hub - COVID-19

Health Inequalities Hub
RCGP elearning updated 8 March 2021

• Information about health equity and caring for socially vulnerable patients during the COVID-19 pandemic. Includes an interview with Sir Michael Marmot, COVID-19 Q&A, COVID-19 vaccine uptake and resources relating to health and equity for socially vulnerable people during the pandemic. Includes a series of evidence reviews to support vaccine update across a range of vulnerable groups including BAME, migrants, remote communities, disabled, prisoners and carers.

What drives GPs in the UK to improve the quality of care? A systematic literature review

What drives general practitioners in the UK to improve the quality of care? A systematic literature review
BMJ Open Quality 2021;10:e001127. doi: 10.1136/bmjoq-2020-001127

• An examination of the evidence behind current incentive schemes available in general practice in the UK found that the majority of research examined QOF. QOF positive effects included reduced mortality rates, better data recording and improved sociodemographic inequalities. However, limitations involved decreased quality of care in non-incentivised activities, poor patient experiences due to tick-box exercises and increased pressure to meet non-specific targets. Findings surrounding competition were mixed, with limited evidence found on the use of non-financial incentives in primary care.

Understanding factors that enabled digital service change in general practice during the Covid-19 pandemic

Understanding factors that enabled digital service change in general practice during the Covid-19 pandemic
Kings Fund 10 February 2021

• This report looks at how the COVID-19 pandemic caused general practice to change and the digital tools and services that were used to facilitate that change. It looks particularly at the wider factors that enabled change and what might need to be done to sustain these changes after the response to the pandemic.

Calculating Quality Reporting Service (CQRS) on NHS CSU Collaborative

Calculating Quality Reporting Service (CQRS)
NHS CSU Collaborative

• The Calculating Quality Reporting Service (CQRS) is an approvals, reporting and payments calculation system for GP practices. It helps practices to track, monitor and declare achievement for the Quality and Outcomes Framework (QOF), Direct Enhanced Services (DES) and Vaccination and Immunisation (V&I) programmes.
• NHSX has been working collaboratively with the NHS Commissioning Support Units to bring provision of the CQRS national system in-house from 1 November 2020.

Level or not? Comparing general practice in areas of high and low socioeconomic deprivation in England

Level or not? Comparing general practice in areas of high and low socioeconomic deprivation in England
Health Foundation September 2020 https://doi.org/10.37829/HF-2020-RC13

• This briefing seeks to explore the extent to which the inverse care law, as defined by the British GP Julian Tudor Hart, still applies to general practice in England nearly 50 years on from its first description.

Digital health: the changing landscape of how we access GP services

Digital health: the changing landscape of how we access GP services
AXA PPP Healthcare and the Centre for Economics and Business Research (CEBR) July 2020

• This report explores the scope for general practice services to further embrace digitally delivered care and support to patients. It looks at how offering online consultations as a first point of contact could increase efficiencies by reserving face-to-face consultations for those identified as needing them – a message that has been reinforced since the Covid-19 pandemic.

How has COVID-19 affected service delivery in GP practices that offered remote consultations before the pandemic?

How has COVID-19 affected service delivery in GP practices that offered remote consultations before the pandemic?
Health Foundation 16 July 2020

• Analysis of 51 GP practices using askmyGP prior to March 2020, and how primary care access, supply and demand has varied during COVID-19. Results suggest practices familiar with conducting appointments remotely were able to adapt quickly to the demands of COVID-19 and undertake more care remotely without significantly impacting the total number of consultations delivered.

Results

An evaluation of the clinical microsystems approach in general practice quality improvement

An evaluation of the clinical microsystems approach in general practice quality improvement
Primary Health Care Research & Development volume 21, 23 June 2020. doi.org/10.1017/S1463423620000158

• A clinical microsystem (CMS) is defined as a ‘small group of people who work together on a regular basis to provide care to discrete subpopulation of patients". This study was commissioned by a CCG in South East England that introduced CMS within its member practices in 2013 and supported a funding stream to enable this. 
• This evaluation explored the experiences of GP staff participating in a CMS and suggest that CMS relies on: establishing a contract between coach and GP to promote buy-in; a flexible approach; identifying a champion at the outset; the use of outcome measures that demonstrate not only the impact on process and systems but also the wider benefits for staff and patients; and follow-up after completion of a project to boost motivation, review progress and refresh skills.

Abstract

Virtual multidisciplinary team meetings for the older population.

COV.43: Virtual multidisciplinary team meetings for the older population.
NIHR ARC West 13 May 2020

• The COVID-19 pandemic means that multidisciplinary team meetings to discuss patient care are unable to take place face-to-face. This review explored the use of virtual MDTs as an alternative. 
• A review of available evidence finds that virtual multidisciplinary team (vMDT) meetings might be an integral component for elderly population care. vMDTs have potential benefits, emphasising the possibility of bringing professionals from different backgrounds to work together and provide more integrated, efficient, accessible, and higher quality care overcoming geographical and timing barriers. vMDTs usually have some disadvantages or barriers for their implementation, emphasising the need of a proper infrastructure and good, designated co-ordination.

Covid19 - General Practice the next phase of care - Wessex LMCs

Covid19 - General Practice the next phase of care

Wessex LMCs 13 May 2020

• In the light of the COVID-19 pandemic and its ongoing impact, Wessex LMCs have been considering services going forward and how to deliver services whilst we co-exist with COVID-19. It has considered
• How can this be done safely?
• Where should we start?
• What has changed in the last couple of months that we want to retain?
• Will we determine what the 'new normal' General Practice looks like, or will this be determined nationally?
• The LMC has produced 2 discussion documents :–
• A briefing document which includes a summary, key recommendations and a conclusion click here to view.
• A full document which provides links and examples and further explores the questions practices are facing currently, click here to view

Remote Working in Primary Care Guidance for GP Practices during COVID-19 Emergency Response

Remote Working in Primary Care Guidance for GP Practices during COVID-19 Emergency Response
Appendix to Securing Excellence in Primary Care (GP) Digital Services: The Primary Care (GP) Digital Services (version 4)
NHSX 30 March 2020

• This appendix to the GP IT Operating Model sets out additional guidance for CCGs and their IT delivery partners that will support practices with options for remote working. It sets out remote working options, Use of smartcards in remote working environment.
• Appendix A - Minimum Personal Equipment Specification

Realising digital-first primary care: Shaping the future of UK healthcare

Realising digital-first primary care: Shaping the future of UK healthcare
Deloitte February 2020

• This report focuses on digitalisation of primary care and discusses the current state, challenges and potential of digital transformation in general practice. It highlights the key steps needed to improve the adoption of technology by patients, practitioners and the wider healthcare system. The over-riding message is clear: if primary care is to survive and thrive, it has to make the most of technology.

Future GP IT systems and services

Future GP IT systems and services
NHS Digital 21 January 2020

• The GP IT Futures programme is a critical enabler for taking primary care towards the requirements set out in the NHS Long Term Plan, five year framework for GP contract reform and the Digital, Data and Technology Vision. This replaces the contractual framework GP System of Choice (GPSoC), to supply IT systems and services to GP practices and associated organisations in England.

Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review

Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review
British Journal of General Practice 2019; 69 (689): e809-e818. DOI: https://doi.org/10.3399/bjgp19X706745

• A systematic review of literature around electronic clinical decision support tools (eCDSTs) to support cancer diagnosis in primary care indicates that eCDSTs have the capacity to improve decision making for a cancer diagnosis, but the optimal mode of delivery remains unclear. The authors conclude that "Although such tools could assist GPs in the future, further well-designed trials of all eCDSTs are needed to determine their cost-effectiveness and the most appropriate implementation methods."

Abstract

Quality improvement in general practice: what do GPs and practice managers think?

Quality improvement in general practice: what do GPs and practice managers think?
Health Foundation December 2019

• A survey of over 2,300 GPs and 1,400 practice managers across the UK has found that most GPs and practice managers see quality improvement as a core aspect of their work, with 99% reporting undertaking QI activities, and many working collaboratively with neighbouring practices to improve services. However, there are many issues making it difficult to deliver improvement, including high patient demand and staff shortages; demands of other NHS agencies; lack of protected time; and level of improvement capability.

Interactive guide to the GP Contract

Interactive guide to the GP Contract

• NHS England (South) and the South West Academic Health Science Network have developed an interactive guide which outlines key changes in the GP contract from 2019.​