Collaborative improvement in Scottish GP clusters after the Quality and Outcomes Framework: a qualitative study

Abstract

Background: Scotland abolished the Quality and Outcomes Framework (QOF) in April 2016, prior to implementing a new Scottish GP contract in April 2018. Since 2016, groups of practices (GP clusters) have been incentivised to meet regularly, to plan and organise quality improvement (QI) as part of this new direction in primary care policy. Aim: To understand the organisation and perceived impact of GP clusters, including how they use quantitative data for improvement. Design/Setting/Methods: Thematic analysis, of semi-structured interviews with key stakeholders (n=17) and observations of GP cluster meetings (n=6) in two clusters. Results: There was uncertainty whether GP clusters should focus on activities generated internally or externally by the wider healthcare system (e.g. from Scottish Health Boards), although the two clusters we observed generally generated their own ideas and issues. Clusters operated with variable administrative/managerial and data support, and variable baseline leadership experience and QI skills. Qualitative approaches formed the focus of collaborative learning in cluster meetings, through sharing and discussion of member practices’ own understandings and experiences. We observed less evidence of data analytics being championed in these meetings, partly because of barriers accessing the analytics data and existing data quality. Conclusion: Cluster development would benefit from more consistent training and support for cluster leads in small group facilitation, leadership and QI expertise, and data analytics access and capacity. Whilst GP clusters are up and running, their impact is likely to be limited without further investment in developing capacity in these areas.

Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads

“…Our findings on the continuing slow progress on cluster working is consistent with our previous research [12,13] and with a newly published report by Healthcare Improvement Scotland [22]. Indeed, concerns raised in a high-level workshop organised by the SSPC in 2016, that poor infrastructure support would be a barrier to effective cluster working, appear to have been borne out [23].…”

“…There has been no published evaluation of the expansion of the MDT in Scotland. A national survey of GP clusters in Scotland conducted in 2018 by the Scottish School of Primary Care (SSPC) found that whilst clusters were "up and running", there was a perceived general lack of structural support, training and capacity building [12], which was supported by subsequent qualitative interviews with a range of different stakeholders [13]. The aim of the present study was to investigate the views of key national primary care stakeholders (PCSs) and CQLs working in three different Health Board areas of Scotland (high deprivation, mixed/affluent, remote and rural) on the GP contract and wider primary care reforms.…”

Understanding how and why quality circles improve standards of practice, enhance professional development and increase psychological well-being of general practitioners: a realist synthesis

“…Our understanding that QCs should be embedded in a system of QI that values, integrates and uses new external knowledge aligns with the existing literature 22 23. Health systems should provide training in QI tools and give access to trustworthy data (explicit knowledge) that help participants identify their own learning needs (CMO configuration 1 b-c and 3 e in figure 2 24–28…”

How and why do Quality Circles work for General Practitioners - a realist approach

“…23 46 Health systems should provide training in QI tools and give access to trustworthy data (explicit knowledge) that help participants identify their own learning needs (CMO configuration 1 b-c and 3 e in Figure 2). 22 47-50…”