IHI Visit to Primary Care – How to use QI to tackle complex problems in a growing directorate

By Vernanda Julien, Improvement Advisor

On Tuesday 30^th April 2024, the Primary Care directorate were delighted to host Derek Feeley (former CEO of the Institute of Health Improvement and former CEO of NHS Scotland) at their annual Institute for Healthcare Improvement (IHI) visit. Primary Care has recently added four new practices to the directorate and this session provided the opportunity for the old and new practices to come together to discuss ways to embed QI as the way to tackle complex problems within the directorate.

Figure 1. Map of services in the Primary Care Directorate

The visit commenced with a “positive gossip” session which allowed the group to applaud each other’s successes over the last year. We heard about awards won by Cauldwell Medical Centre and Health E1 practices and the increase in active patient engagement across the practices. Two teams then had the opportunity to share insights into their improvement work.

Kingsway and Bramingham Medical Centre in Luton discussed their work to reduce inequalities in their patient population by increasing access to non-English speaking communities. Driven by the Core20PLUS5 approach, the team explored areas of inequalities in their patient population and identified Urdu speakers as the largest non-English speaking population they serve (26%) and having one of the lowest uptake of their services. Luton has the highest prevalence of diabetes in the North East of England with 8.4% of people diagnosed. They also have the lowest uptake of cervical smears and childhood immunisation in the Bedford, Luton and Milton Keynes Integrated Care System.  The team in partnership with the People Participation Group have started exploring the factors contributing to the barriers to accessing their service and will now work to engage with these communities to further explore these barriers and commence testing their change ideas.

Figure 2 Fishbone Diagram exploring the factors contributing to the unequal access to non-English speaking patients in Kingsway and Bramingham Medical Centre

Health E1, a specialist homeless health primary care practice in Tower Hamlets, discussed their work to improve their hepatitis C (HCV) testing for their patient group. The work was commissioned by the NHS England Hepatitis C Elimination Programme that aims to work with practices that are in a high index of deprivation to improve HCV testing and treatment pathways in primary care. The project involves co-production between people with lived experience of homelessness and HCV. The practice has commenced the testing of a drop-in clinic led by a lived experience and Hepatitis C lead and are working in partnership with local organisations who will be supporting the clinic.

The session also provided attendees with the opportunity to reflect on ways to increase their use of QI to tackle complex problems and consider what their next steps should be. Derek provided some valuable insight on the importance of not working in silos and building deeper connections across the directorates to share learning and create opportunities for collaborative working.