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NHS reporting demands are preventing quality improvements, say GPs

Almost all GPs say the demands of other NHS bodies, such as their reporting requirements, are stopping them from carrying out quality improvement activities, according to a new survey.

Researchers at the London School of Hygiene and Tropical Medicine – commissioned by the Health Foundation think tank – surveyed 2,377 GPs and 1,400 practice managers in the UK asking about quality improvement (QI) in general practice.

They found that while GPs see QI as a core aspect of general practice, 95% of them reported the ‘demands of other NHS agencies’, and also high patient demand as barriers.

In addition, 84% of GPs said clinical staff shortages are preventing them from delivering improvements.

The report said these factors are making it harder for GPs to be in the right ‘headspace’ to consider areas of their practice to improve on.

It said: ‘The level of demand from patients added to clinical staff shortages will inevitably restrict the time available for working on QI initiatives. They will also mean that it is harder to find the “headspace” to be able to step back from day-to-day work to look at the practice and consider areas for improvement.’

Researchers found the main areas of QI activity reported by GPs were: prescribing; access; chronic disease management; end-of-life-care; health promotion; and collaborating with other practice.

The report added that, unlike in secondary care, general practice does not have a formal infrastructure to allow for ‘protected’ time to focus on training.

The report said: ‘The lack of protected time to plan and design improvement (a key difference from QI in secondary care) also emerged as a major challenge for almost 80% of GPs.’

It continued: ‘As the improvement programmes supported by the Health Foundation over the past decade have shown, it is almost impossible to embed and sustain an intervention without careful reflection and planning upfront.’

However, despite the challenges the vast majority of participants reported undertaking quality improvement at some point, with only 16 GPs reporting no QI activity.

Additionally, only 42% of GPs said external funding for QI was helpful, which the Health Foundation said may be due to the ‘added bureaucracy’ in creating plans and reporting outcomes.

The research follows new quality improvement modules drawn up by NHS England that were announced earlier this year, which mean in 2020 practices will focus on improving care for patients with learning disabilities.