Quality and Patient Safety in Irish General Practice

1. Quality and Patient Safety in Irish General Practice
ICGP Mallow 14 November 2012
Edwina Dunne
Director Quality Patient Safety Audit
Quality and Patient Safety Directorate
Health Services Executive

2. Directorate of Quality and Patient
Safety
Responsibility for:
 Quality improvement
 Risk Management
 Service user involvement and advocacy
 Management of serious adverse incidents
 National audit
 Patient safety programmes
 Clinical governance and clinical directors
 Relationship with HIQA IMC and SCA
 HCAI

3. Directorate QPS cont
 QPS audit to provide level 2.
assurance to address the assurance
‘gap’ at corporate governance level
for clinical and primary care.
 Controls Assurance process for CEO
to sign CAS now integrated.
 Collaborative approach includes all
services. Including SLA.
 Focus on Leadership &Governance

4. Corporate and
Clinical Governance
“The main lesson I take
form the problems at Mid-
staffs is that in future, we
must never separate quality
and financial data.
They are always two sides of
the same coin.” (Secretary of State for
Health, England)

5. For: everyone Information Leaflet

6. For: Multidisciplinary Teams
Published October 2012

7. How to Use the Prompts

8. The Context
 Primary care teams/strategy
 Acute hospital networks
 New interim HSE directorates
 Major chronic disease challenge
 Major financial challenge
 National standards
 Government policy on UHI
 Continuing focus on ED and OPD waits

9. Quality in Irish General Practice
 CME network
 Quality vocational training – big HSE
investment
 Structured diabetes care programme
 ICGP Quality in Practice initiatives
 Out of hours cover – integrating practices
 Same day access, cervical screening and
immunisations
 ICT penetration – disease registers
 Peer practice visits
 Leadership – ICGP and academia

10. Q+PS challenges in general practice
 Lack of information, benchmarking
 Variability
 Isolated GPs
 Lack of use of guidelines and risk assessment
tools
 Out of Hours cover and patient info
 Transitions of care
 Medication reconciliation and prescribing errors
 Minority group and disability access
 Lack of critical incident/near-miss review

11. Future options to improve quality
• Involve local community/patients
• Real PCT development, involve pharmacy
• PCT network to engage with hospital trusts – clinical
leadership
• Work together to manage standards burden
• Audit shared across multiple practices – benchmark
and share learning
• Measuring performance – prescribing data:
preventative inhalers, statin dosage, PPI duration,
benzos and antibiotic use – CUT COSTS
• Collaborative prescribing – community pharmacy
partnership
• ICT supported decision prompts, guidelines and risk
tools

12. Irish general practice demonstrates
high quality
 Central role of ICGP and clinical leaders
in general practice
 Lack of information on clinical care
process
 Lack of accountability for state funding
 Variation and outliers inevitable
 We need to work together to improve
quality through training, evidence use
and acceptable performance
measurement

13. Where do we start?
 Governance and Leadership
 Who is accountable and responsible
 To whom for what?
 Who is the team is it really a MDT?
 This is not just about Standards but
a change of behaviour!

14. Changes
 Changes come from small initiatives
which work, initiatives when
initiated become fashion. We cannot
wait for the great visions from great
people, we must light our own small
fires in the darkness.
 Charles Handy

15.  Thank you. All suggestions most
welcome and if we can assist
you contact :
philip.crowley@hse.ie N.D,QPS
Edwina.Dunne@hse.ie QPSA
Maureen.Flynn@hse.ie C.G
Mary.Brown@hse.ie N.S.