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DELIVERING QUALITY IN PRIMARY CARE: THE JOURNEY SO FAR <ul><li>Sir Lewis Ritchie  </li></ul><ul><li>Chair  </li></ul><ul><...
THE JOURNEY SO FAR <ul><li>Reflecting back........... </li></ul>
 
 
 
 
THE JOURNEY SO FAR <ul><li>Putting quality on the map...........  </li></ul><ul><li>.......a national perspective....... <...
 
The Journey So Far <ul><li>Delivering Quality in  Primary Care  (DQPC)..... </li></ul><ul><li>So:  </li></ul><ul><li>What ...
The Journey So Far <ul><li>A reminder of why we set out on this journey: </li></ul><ul><ul><ul><li>- Huge challenges facin...
The Journey So Far <ul><li>A reminder of why we set out on this journey, cont… </li></ul><ul><ul><ul><li>Primary care a cr...
2010 engagement process <ul><li>6 regional events, 700 attendees from all PC players.... </li></ul><ul><li>Some key themes...
Follow up <ul><li>Determined there should be  actions  as result – leading to a:  Delivering Quality in Primary Care Actio...
Overarching themes <ul><li>Will mention a few of the actions, but first three very important overarching themes:  </li></u...
Overarching themes <ul><ul><ul><li>Primary care's place at the table… </li></ul></ul></ul><ul><ul><ul><li>“ We need to mak...
Overarching themes <ul><ul><ul><li>Primary care's place at the table… </li></ul></ul></ul><ul><ul><ul><li>Key part in the ...
Overarching themes <ul><li>2 – Need for grown up relationship with all independent contractors : </li></ul><ul><li>For too...
Overarching themes <ul><li>3 – The Leadership Imperative : </li></ul><ul><ul><ul><li>Visionary and vigilance </li></ul></u...
What’s the bottom line? <ul><li>Actions set out in DQPC plan. Not list all now: a number, including local, will be showcas...
What’s the bottom line? <ul><ul><ul><li>Highlights continued… </li></ul></ul></ul><ul><ul><ul><li>GP access : toolkit deve...
What’s the bottom line? <ul><li>Looking forward to hearing your reactions on the journey so far and what lies ahead </li><...
WHATS GOING ON OUT THERE?   PRIMARY CARE IN SCOTLAND DR SHEENA L MACDONALD Senior Medical Adviser  Scottish Government
The Complete Works of William Shakespeare (Abridged) By Adam Long, Daniel Singer and Jess Winfield Damien Devine and Red L...
WHO DO WE SEE? Estimated number of patient contacts by discipline Financial years 2003/04 to 2009/10 0 5 10 15 20 25 30 20...
WHAT DO WE SEE? <ul><li>Top 10 conditions - GP and practice nurse per 1,000   </li></ul>0 40 80 120 160 200 240 280 Circul...
WHAT HAPPENS TO THEM? <ul><li>“ view the NHS as a service delivered predominantly in local communities rather than in hosp...
WHAT HAPPENS TO THEM? <ul><li>Around 1 in 50 GP consultations results in an emergency inpatient admission. Thus 1000 GP co...
LOTHIAN EXPERIENCE <ul><li>10% of practice population contact their practice every week </li></ul><ul><li>87% managed in P...
SO WHY BOTHER? 0 500 1,000 1,500 2,000 2,500 Global Sum QoF Premises  Enhanced Services Board Administered Funds Unplanned...
SO WHAT ARE WE DOING? <ul><li>The Quality Strategy & DQPC </li></ul><ul><li>Closer working – look at variation and engage ...
QPQOF <ul><li>3  work-streams – referrals, admissions and prescribing  </li></ul><ul><li>3 activities – internal review of...
And so to the Future… <ul><li>Continue to develop QPQOF and emphasis on whole system working </li></ul><ul><li>“ Care deli...
Improving Patient Safety in Primary Care  - The story so far  Neil Houston, NHS Forth Valley
SUB HEADING
SUB HEADING
Safety Improvement in Primary Care  (SIPC 1)
Aims: To enable 80 Primary Care teams to: 1.Identify and reduce harm  to patients 2. Improve reliability of care  for pati...
Knowledge <ul><li>Topics </li></ul><ul><li>Tools </li></ul><ul><li>What to spread? </li></ul><ul><li>How to spread?   </li...
1. Reliable Care – Care Bundles   4 or 5 elements of care Evidence based Across Patients Journey  Creates teamwork Done re...
Heart Failure Bundle <ul><ul><li>1.Maximise medical therapy  – </li></ul></ul><ul><ul><li>On a licensed B Blocker </li></u...
Bundles - Successes “ The care bundles were useful because it identified gaps” Revealing unreliable practice Indicating ar...
2 – Data
Seeing Improvement “ You can see week by week, month by month, whether or not you are showing any improvement, we seem to ...
Tayside
Lothian
Outcome Data
Trigger Tools To identify and reduce harm
SUB HEADING
SUB HEADING
 
Expectations Hard to do  Time Consuming Would not find harm Threatening
Experience <ul><li>Challenges </li></ul><ul><li>Logistics </li></ul><ul><li>Training support </li></ul><ul><li>Variation <...
“ Seemed a bit intimidating when we first had it presented to a large group … much easier to use in practice … it’s a rema...
Safety Culture
Safety Climate Survey <ul><li>On line </li></ul><ul><li>Practice report </li></ul><ul><li>Measurement </li></ul><ul><li>Di...
Insights “ Many of us in the practice staff hadn’t really made the link that us failing to communicate in was a threat to ...
Experience so Far Practices are interested  Acts as a catalyst Need guidance and support Better process and report Challen...
Developing a Programme <ul><li>Scoping  </li></ul><ul><li>Develop aims/measures/tools </li></ul><ul><li>Implementation str...
Productive General Practice Susan Bishop & Mary Freel
Aim <ul><li>Introduce the Lean context for Productive General Practice and describe PGP’s structure </li></ul><ul><li>Expl...
Productive General Practice uses Lean Principles <ul><li>Specify   what does & does not add   value   – from the patient’s...
Why is it relevant? <ul><li>Lean is a systematic approach to   reducing waste   through a process of   continuous improvem...
The benefits it offers… Stanley Medical Group, County Durham <ul><li>Reviewed their recall system for patients needing rou...
The benefits it offers..  William Brown Centre, Peterlee <ul><li>Practice nurse team applied 5S, a fundamental lean tool t...
The background to PGP in Scotland <ul><li>Focus on improving both quality and efficiency  </li></ul><ul><li>Delivering Qua...
 
Productive General Practice in Scotland <ul><li>UK launch in November </li></ul><ul><li>Grampian, Tayside and Glasgow deve...
The Crescent Medical Practice Patient survey response 96%
The Crescent Medical Practice How do staff feel about practice?
The Crescent Medical Practice  How do staff feel about practice? 1.83 2.22 2.09 2.04 2.10 1.91 Whole Practice 0.4 0.5 0.7 ...
NHS  Lothian’s PC Forward Group Duncan Miller   General Manager, Primary Care Contracts, NHS Lothian
DELIVERING QUALITY IN PRIMARY CARE: THE JOURNEY SO FAR <ul><li>Closing thoughts...... </li></ul>
Securing success…. <ul><li>Empowered patients – high quality preventive and reactive health care </li></ul><ul><li>Enabled...
Success is a journey….. not a destination!
Thank you for listening Thank you for coming  and participating
Reminder Invitation You will be most welcome to attend our Delivering Quality in Primary Care Fringe Session ...... 4:45-7...
<ul><li>Questions/ thoughts/ comments…? </li></ul>
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Quality, Innovation, Productivity and Prevention in Primary Care

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What do the Quality Ambitions mean for Primary Care? This session describes the ongoing innovative local improvements and national work with NHS
Boards and Primary Care contractors to improve quality, efficiency and outcomes as well as the future plans for Primary Care.

Published in: Health & Medicine
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Quality, Innovation, Productivity and Prevention in Primary Care

  1. 1. DELIVERING QUALITY IN PRIMARY CARE: THE JOURNEY SO FAR <ul><li>Sir Lewis Ritchie </li></ul><ul><li>Chair </li></ul><ul><li>DQPC Steering Group </li></ul>
  2. 2. THE JOURNEY SO FAR <ul><li>Reflecting back........... </li></ul>
  3. 7. THE JOURNEY SO FAR <ul><li>Putting quality on the map........... </li></ul><ul><li>.......a national perspective....... </li></ul>
  4. 9. The Journey So Far <ul><li>Delivering Quality in Primary Care (DQPC)..... </li></ul><ul><li>So: </li></ul><ul><li>What does the Quality Strategy mean for primary care? </li></ul><ul><li>What can primary care bring to the table? </li></ul>
  5. 10. The Journey So Far <ul><li>A reminder of why we set out on this journey: </li></ul><ul><ul><ul><li>- Huge challenges facing NHS – demography (60% increase in over 75s over next 20 years), money: ring fencing but still £300 million efficiencies </li></ul></ul></ul>
  6. 11. The Journey So Far <ul><li>A reminder of why we set out on this journey, cont… </li></ul><ul><ul><ul><li>Primary care a critical part of the solution. 90% of contacts; 23 million GP consultations; 1.9 million eye examinations; 91 million prescriptions dispensed, highly trained and capable resource...... </li></ul></ul></ul><ul><ul><ul><li>- But..... a sense of a dis‑engagement in recent years. So...need to re‑engage and re‑energise. </li></ul></ul></ul>
  7. 12. 2010 engagement process <ul><li>6 regional events, 700 attendees from all PC players.... </li></ul><ul><li>Some key themes to emerge: </li></ul><ul><ul><ul><li>- Enthusiasm for the dialogue. Much scope for greater integration </li></ul></ul></ul><ul><ul><ul><li>- Finances a huge challenge but in every place people up for being part of the solution </li></ul></ul></ul><ul><ul><ul><li>Real issues around motivation but quality seen as potential to be a key motivator </li></ul></ul></ul>
  8. 13. Follow up <ul><li>Determined there should be actions as result – leading to a: Delivering Quality in Primary Care Action Plan </li></ul><ul><li>DQPC Action Plan: not an exhaustive (and exhausting) list nor a rival to the QS. But key national actions which would make the biggest difference. </li></ul><ul><li>Overseen by DQPC Steering Group. Bookend event – today: do stay! – to keep us honest and help refresh the plan. </li></ul>
  9. 14. Overarching themes <ul><li>Will mention a few of the actions, but first three very important overarching themes: </li></ul><ul><ul><ul><li>1 - Primary care's place at the table . Vital part of the solution. WHO has always said so. Increasingly recognised here </li></ul></ul></ul>
  10. 15. Overarching themes <ul><ul><ul><li>Primary care's place at the table… </li></ul></ul></ul><ul><ul><ul><li>“ We need to make sure people are admitted to hospital only when it is not possible or appropriate to treat them in the community ... doing all of these things will result in changes in the pattern of acute care and.. fewer acute beds and, as long as it is appropriate and as a result of the kind of service change we want to see, we should see that as a positive” </li></ul></ul></ul><ul><ul><ul><li>(Cabinet Secretary to Parliament, June 2011) </li></ul></ul></ul>
  11. 16. Overarching themes <ul><ul><ul><li>Primary care's place at the table… </li></ul></ul></ul><ul><ul><ul><li>Key part in the Health Boards’ annual review process. </li></ul></ul></ul><ul><ul><ul><li>Today’s PC events as integral part of annual NHS Scotland event. </li></ul></ul></ul>
  12. 17. Overarching themes <ul><li>2 – Need for grown up relationship with all independent contractors : </li></ul><ul><li>For too long we’ve kept each other at arms length </li></ul><ul><li>Multi-professional Involvement in DQPC Steering Group, in individual actions and as day‑by‑day partners </li></ul>
  13. 18. Overarching themes <ul><li>3 – The Leadership Imperative : </li></ul><ul><ul><ul><li>Visionary and vigilance </li></ul></ul></ul><ul><ul><ul><li>Enablement and encouragement </li></ul></ul></ul><ul><ul><ul><li>Courage and example </li></ul></ul></ul>
  14. 19. What’s the bottom line? <ul><li>Actions set out in DQPC plan. Not list all now: a number, including local, will be showcased at 5.15pm </li></ul><ul><li>A few highlights: </li></ul><ul><ul><ul><li>- eye care integration : potential to revolutionise primary/secondary care link </li></ul></ul></ul><ul><ul><ul><li>prevention : Keep Well and Childsmile rolled out; £70m Change Fund </li></ul></ul></ul>
  15. 20. What’s the bottom line? <ul><ul><ul><li>Highlights continued… </li></ul></ul></ul><ul><ul><ul><li>GP access : toolkit developed with profession </li></ul></ul></ul><ul><ul><ul><li>developing a HEAT target on timely, accurate info at the primary/secondary care interface </li></ul></ul></ul><ul><ul><ul><li>leadership : launch tomorrow of Strategic Clinical Leadership network; plus joint RCGP/ NES initiative on leadership in primary care </li></ul></ul></ul>
  16. 21. What’s the bottom line? <ul><li>Looking forward to hearing your reactions on the journey so far and what lies ahead </li></ul><ul><li>Meanwhile: some more detail on 3 of the key areas of activity </li></ul><ul><ul><li>Primary /secondary care interface </li></ul></ul><ul><ul><li>Patient safety and </li></ul></ul><ul><ul><li>“ Productive General Practice” </li></ul></ul>
  17. 22. WHATS GOING ON OUT THERE? PRIMARY CARE IN SCOTLAND DR SHEENA L MACDONALD Senior Medical Adviser Scottish Government
  18. 23. The Complete Works of William Shakespeare (Abridged) By Adam Long, Daniel Singer and Jess Winfield Damien Devine and Red Lion Theatres New Red Lion Theatre Review by Simon Sladen (2011) Take 90 minutes, 37 plays, 3 actors, 1 famous bard, blitz them in a theatrical blender and what do you get? An evening of pure Shakespearean fun courtesy of The Complete Works of William Shakespeare (Abridged) .
  19. 24. WHO DO WE SEE? Estimated number of patient contacts by discipline Financial years 2003/04 to 2009/10 0 5 10 15 20 25 30 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 Financial Year Contacts [million] Health Visitor District Nurse Practice Nurse General Practitioner
  20. 25. WHAT DO WE SEE? <ul><li>Top 10 conditions - GP and practice nurse per 1,000 </li></ul>0 40 80 120 160 200 240 280 Circulatory and respiratory S&S General abnormal S&S NEC Hypertension Diseases of the skin & subcutaneous tissue Digestive/abdominal S&S Neurological/musculoskeletal S&S Psychological S&S Diabetes Soft tissue disorders Infectious diseases GP & PN contact rate per 1,000 population GP PN
  21. 26. WHAT HAPPENS TO THEM? <ul><li>“ view the NHS as a service delivered predominantly in local communities rather than in hospitals; 90% of health care is delivered in primary care but we still focus the bulk of our attention on the other 10% - our current emphasis on hospitals does not provide the care that people are likely to need.” </li></ul><ul><li>Professor David Kerr 2005 </li></ul>
  22. 27. WHAT HAPPENS TO THEM? <ul><li>Around 1 in 50 GP consultations results in an emergency inpatient admission. Thus 1000 GP consultations will result in 20 emergency inpatient admissions. If all GPs were able to refer only one fewer person in 1000 consultations ( i.e. referring 19 rather than 20 individuals), it would produce a 5% reduction in GP referred emergency admissions. </li></ul><ul><li>Professor David Kerr 2005 </li></ul>
  23. 28. LOTHIAN EXPERIENCE <ul><li>10% of practice population contact their practice every week </li></ul><ul><li>87% managed in Primary Care for next 4 weeks </li></ul><ul><li>13% - 48% OPD </li></ul><ul><li>6% A&E </li></ul><ul><li>10% admissions </li></ul><ul><li>i.e. 2% result in unscheduled activity or 1.3% resulting in direct admission </li></ul>
  24. 29. SO WHY BOTHER? 0 500 1,000 1,500 2,000 2,500 Global Sum QoF Premises Enhanced Services Board Administered Funds Unplanned Admissions Prescribing New Outpatient attendances Direct access A&E £m Non Contracted=£3.7bn Contracted=£700m
  25. 30. SO WHAT ARE WE DOING? <ul><li>The Quality Strategy & DQPC </li></ul><ul><li>Closer working – look at variation and engage in a dialogue – 20% reduction in plain x-rays from one board 40% reduction in dermatology referrals form another </li></ul><ul><li>QPQOF </li></ul>
  26. 31. QPQOF <ul><li>3 work-streams – referrals, admissions and prescribing </li></ul><ul><li>3 activities – internal review of data, external peer review of data, agree on actions for prescribing and care pathways for referrals and emergency admissions </li></ul>
  27. 32. And so to the Future… <ul><li>Continue to develop QPQOF and emphasis on whole system working </li></ul><ul><li>“ Care delivered at the right time in the right place by the right person” </li></ul><ul><li>Align local and national enhanced services to support </li></ul><ul><li>Support AHP and Community Nursing to realign work priorities to support people to remain out of institutional care </li></ul>
  28. 33. Improving Patient Safety in Primary Care - The story so far Neil Houston, NHS Forth Valley
  29. 34. SUB HEADING
  30. 35. SUB HEADING
  31. 36. Safety Improvement in Primary Care (SIPC 1)
  32. 37. Aims: To enable 80 Primary Care teams to: 1.Identify and reduce harm to patients 2. Improve reliability of care for patients On High Risk Medications With Heart Failure 3.Develop safety Culture 4.Involve Patients in QI
  33. 38. Knowledge <ul><li>Topics </li></ul><ul><li>Tools </li></ul><ul><li>What to spread? </li></ul><ul><li>How to spread? </li></ul>
  34. 39. 1. Reliable Care – Care Bundles 4 or 5 elements of care Evidence based Across Patients Journey Creates teamwork Done reliably All or nothing Small frequent samples
  35. 40. Heart Failure Bundle <ul><ul><li>1.Maximise medical therapy – </li></ul></ul><ul><ul><li>On a licensed B Blocker </li></ul></ul><ul><ul><li>B Blocker at max tolerated dose </li></ul></ul><ul><ul><li>2.Functional assessment - NYHA recorded in last year </li></ul></ul><ul><ul><li>3.Immunisation - pneumococcal vaccine ever </li></ul></ul><ul><ul><li>4.Self Management- information given to patient on recognition of deterioration </li></ul></ul><ul><ul><li>Improve QOL </li></ul></ul><ul><ul><li>Reduce admissions </li></ul></ul>
  36. 41. Bundles - Successes “ The care bundles were useful because it identified gaps” Revealing unreliable practice Indicating areas for improvement
  37. 42. 2 – Data
  38. 43. Seeing Improvement “ You can see week by week, month by month, whether or not you are showing any improvement, we seem to be improving and that’s good”
  39. 44. Tayside
  40. 45. Lothian
  41. 46. Outcome Data
  42. 47. Trigger Tools To identify and reduce harm
  43. 48. SUB HEADING
  44. 49. SUB HEADING
  45. 51. Expectations Hard to do Time Consuming Would not find harm Threatening
  46. 52. Experience <ul><li>Challenges </li></ul><ul><li>Logistics </li></ul><ul><li>Training support </li></ul><ul><li>Variation </li></ul><ul><li>?For measurement </li></ul>Positives Quick Finding Harm Cultural change Improvement
  47. 53. “ Seemed a bit intimidating when we first had it presented to a large group … much easier to use in practice … it’s a remarkably effective tool for reflective analysis on patient safety and other clinical issues …has created a lot of interest from other doctors in the practice as a tool for professional development and for appraisals” Doctor Gordon Cameron GP Edinburgh
  48. 54. Safety Culture
  49. 55. Safety Climate Survey <ul><li>On line </li></ul><ul><li>Practice report </li></ul><ul><li>Measurement </li></ul><ul><li>Diagnosis </li></ul><ul><li>Catalyst for change </li></ul>
  50. 56. Insights “ Many of us in the practice staff hadn’t really made the link that us failing to communicate in was a threat to patient safety ….we had a lot of really good stuff came out of it, a lot of very open discussion”
  51. 57. Experience so Far Practices are interested Acts as a catalyst Need guidance and support Better process and report Challenges – understanding/using it /anonymity
  52. 58. Developing a Programme <ul><li>Scoping </li></ul><ul><li>Develop aims/measures/tools </li></ul><ul><li>Implementation strategy </li></ul><ul><li>Launch 2013 </li></ul><ul><li>Looking for volunteers….. </li></ul>
  53. 59. Productive General Practice Susan Bishop & Mary Freel
  54. 60. Aim <ul><li>Introduce the Lean context for Productive General Practice and describe PGP’s structure </li></ul><ul><li>Explain how it can support you in Delivering Quality in Primary Care </li></ul><ul><li>Describe how it’s being used and some examples of the benefits it offers </li></ul>
  55. 61. Productive General Practice uses Lean Principles <ul><li>Specify what does & does not add value – from the patient’s perspective. </li></ul><ul><li>Identify steps necessary to design, order and produce across the whole value stream . </li></ul><ul><li>Make those actions flow without interruption, detours, waiting or rework. </li></ul><ul><li>Only make what is pulled by the patient. </li></ul><ul><li>Strive for perfection by continually improving & removing wastes as they are uncovered. </li></ul>
  56. 62. Why is it relevant? <ul><li>Lean is a systematic approach to reducing waste through a process of continuous improvement </li></ul><ul><li>Waste is anything other than the minimum amount of Practice equipment, materials, space and time which are essential to add value to the patient or service. </li></ul><ul><li>A Lean ‘Goal’ is to supply a product or service to the patient’s demand with 100% quality </li></ul><ul><li>Making the right thing easier to do – for every person, every time </li></ul>
  57. 63. The benefits it offers… Stanley Medical Group, County Durham <ul><li>Reviewed their recall system for patients needing routine drug monitoring </li></ul><ul><li>Applied lean principles to understand the current process and design an improved process </li></ul><ul><li>Existing system lead to inconsistencies, waste and patient safety risk </li></ul><ul><li>Results: </li></ul><ul><ul><li>Patient Safety (faster lead time and higher degree of accuracy) </li></ul></ul><ul><ul><li>Time (35 hours/month to 0.53 hours/week) </li></ul></ul><ul><ul><li>Patient experience (increased HCA patient facing time) </li></ul></ul><ul><ul><li>Money (£4150/year) Stanley Medical Group, County Durham </li></ul></ul>Source: Iain Smith, Corporate Improvement Team, North East Transformation System “ Streamlining this process has saved us time but the real benefit has been that we have improved patient safety and the patient experience, as we are now able to offer more appropriate appointments” Sue Elsbury, Practice Manager
  58. 64. The benefits it offers.. William Brown Centre, Peterlee <ul><li>Practice nurse team applied 5S, a fundamental lean tool to their working environment </li></ul><ul><li>Impact </li></ul><ul><ul><li>Reduction in inventory </li></ul></ul><ul><ul><li>Reduction in interruptions to consultations </li></ul></ul><ul><ul><li>Improved efficiency (e.g. staff walking distances reduced from 174 steps/ patient cycle to 18 steps/ patient cycle </li></ul></ul>“ By using simple tools to make simple changes you can made a lot of difference and I would recommend it to anyone thinking of using this approach” Dr Russell, GP Source: Iain Smith, Corporate Improvement Team, North East Transformation System
  59. 65. The background to PGP in Scotland <ul><li>Focus on improving both quality and efficiency </li></ul><ul><li>Delivering Quality in Primary Care Action Plan </li></ul><ul><li>Working partnership </li></ul><ul><ul><li>Scottish Government </li></ul></ul><ul><ul><li>Institute for Innovation and Improvement </li></ul></ul><ul><ul><li>RCGP Scotland </li></ul></ul><ul><ul><li>Quality Improvement Hub </li></ul></ul><ul><ul><li>Primary Care Leads </li></ul></ul>
  60. 67. Productive General Practice in Scotland <ul><li>UK launch in November </li></ul><ul><li>Grampian, Tayside and Glasgow developing, or testing modules </li></ul><ul><li>Early Adopters in Grampian and Tayside starting August </li></ul><ul><li>www.evidenceintopractice.scot.nhs.uk </li></ul><ul><li>Expert advice and coaching Quality & Efficiency Support Team & RCGP </li></ul>
  61. 68. The Crescent Medical Practice Patient survey response 96%
  62. 69. The Crescent Medical Practice How do staff feel about practice?
  63. 70. The Crescent Medical Practice How do staff feel about practice? 1.83 2.22 2.09 2.04 2.10 1.91 Whole Practice 0.4 0.5 0.7 0.6 0.4 0.3 Practice Management 2 2.83 2.5 2.33 2.83 2 Reception 3 3 4 3 4 4 Admin 1 3 1 1 1 1 Nurses 2.75 1.75 2.25 3.25 2.25 2.25 GPs Change And Innovation Work Life Balance Internal Comms Handling Conflict Team Working Decision Making Whole Practice Average
  64. 71. NHS Lothian’s PC Forward Group Duncan Miller General Manager, Primary Care Contracts, NHS Lothian
  65. 72. DELIVERING QUALITY IN PRIMARY CARE: THE JOURNEY SO FAR <ul><li>Closing thoughts...... </li></ul>
  66. 73. Securing success…. <ul><li>Empowered patients – high quality preventive and reactive health care </li></ul><ul><li>Enabled professionals – innovative multi-professional teamwork – pulling together </li></ul><ul><li>Effective leadership – vision, courage and en courage ment </li></ul><ul><li>Excellence in practice – pressing on </li></ul>
  67. 74. Success is a journey….. not a destination!
  68. 75. Thank you for listening Thank you for coming and participating
  69. 76. Reminder Invitation You will be most welcome to attend our Delivering Quality in Primary Care Fringe Session ...... 4:45-7pm today
  70. 77. <ul><li>Questions/ thoughts/ comments…? </li></ul>

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