An evaluation of the clinical microsystems approach in general practice quality improvement

Background: Changes to the general practice (GP) contract in England (April 2019) introduced a new quality improvement (QI) domain. The clinical microsystems programme is an approach to QI with limited evidence in primary care. Aim: To explore experiences of GP staff participating in a clinical microsystems programme. Design and setting: GPs within one clinical commissioning group (CCG) in South East England. Normalisation process theory informed qualitative approach. Method: Review of all CCG clinical microsystems projects using pre-existing data. The Diffusion of Innovation Cycle was used to inform the sampling frame and GPs were invited to participate in interviews or focus groups. Ten practices participated; 11 coaches and 16 staff were interviewed. Results: The majority of projects were process-driven activities related to dministrative systems. Projects directly related to health outputs were fewer and related to externally imposed targets. Four key elements facilitated practices to engage: feeling in control; receiving enhanced service payment; having a senior staff member championing the approach; and good practice–coach relationship. There appeared to be three key benefits in addition to project-specific ones: improved working relationships between CCG and practice; more cohesive practice team; and time to reflect. Conclusion: Small projects with clear parameters were more successful than larger ones or those spanning organisations. However, there was little evidence suggesting the key benefits were unique attributes of the microsystems approach and sustainability was problematic. Future research should focus on cross-organisational approaches to QI and identify what, if any, added value the approach provides

Evaluability Assessments as an Approach to Examining Social Prescribing

We report on two evaluability assessments (EAs) of social prescribing (SP) services in South East England conducted in 2016/7. We aimed to demonstrate how EA can be used to assess whether a programme is ready to be evaluated for outcomes, what changes would be needed to do so and whether the evaluation would contribute to improved programme performance. We also aimed to draw out the lessons learned through the EA process and consider how these can inform the design and evaluation of SP schemes. EAs followed the steps described by Wholey (1987) and Leviton et al. (2010), including collaboration with stakeholders, elaboration, testing and refinement of an agreed programme theory, understanding the programme reality, identification and review of existing data sources and assessment against key criteria. As a result, evaluation of the services was not recommended. Necessary changes to allow for future evaluation included gaining access to electronic patient records, establishing procedures for collection of baseline and outcome data and linking to data on use of other healthcare services. Lessons learned included ensuring that: (i) SP schemes are developed with involvement (and buy in) of relevant stakeholders; (ii) information governance and data sharing agreements are in place from the start; (iii) staffing levels are sufficient to cover the range of activities involved in service delivery, data monitoring, reporting, evaluation and communication with stakeholders; (iv) SP schemes are co-located with primary care services and (v) referral pathways and linkage to health service data systems are established as part of the programme design. We conclude that EA provides a valuable tool for informing the design and evaluation of SP schemes. EA can help commissioners to make best use of limited evaluation resources and prioritise which programmes need to be evaluated, as well as how, why and when

Service Evaluation of the Encompass Community Hub Operating Centres (CHOCS), Report: June 2018

This report details the findings of a service evaluation of the Vanguard Encompass MCP (MultiSpecialty Community Provider) in East Kent. Encompass was awarded Vanguard status in 2015, through the first wave of Vanguards prompted by NHS England’s ‘Five Year Forward View’ strategy. The evaluation was conducted from March 2017 to April 2018 by the Centre for Health Service Studies in partnership with Encompass, who provided and analysed the metric data. The operational model developed and implemented by Encompass is Community Hub Operating Centres (CHOCs). CHOCs are holistic community based models of integrated service delivery aiming to improve user experience of co-ordinated care and self-management at home; contribute to a reduction in A&E demand and onward admission in the short term; and reduce pressure on acute services and long term care home placements in the longer term. Five CHOCs were initiated after an initial pilot period in 2016, which consist of clusters of GP practices serving a total practice population of 180,784 patients. The evaluation focused on the CHOCs, and the evaluation questions were informed by the NHSE local evaluation document (NHS 2015): ? What impact are the CHOCs having on user outcomes and experience? ? What are the components of the care model delivery (or ‘active/successful ingredients’) that are really making a difference? ? What are the influencing contextual factors and how have they affected implementation and outcomes? ? What changes to the use of resources and activity in the local health system have taken place and to what costs? ? What could be improved, replicated and sustained

The feasibility of a multi‐professional training to improve how health care professionals deliver different news to families during pregnancy and at birth

Background: In the United Kingdom, pregnant women are offered foetal anomaly screening to assess the chance of their baby being born with eleven different conditions. How health care professionals (HCPs) deliver news about a child having a congenital anomaly affects how it is received and processed by parents. We refer to this news as different news. Methods: We conducted a mixed methods evaluation of a training intervention to improve how HCPs deliver different news. Twenty‐six HCPs self‐completed pretraining and posttraining questionnaires on skills, knowledge, and attitudes related to delivering different news. Qualitative interviews were conducted with eight HCPs. Quantitative data were analysed using descriptive statistics, the paired t test to compare the pre and post scores and estimate the difference between pre and post scores, and the 95% confidence interval. Qualitative data were analysed using framework analysis guided by the Theoretical Domains Framework (TDF). Results: The training intervention was both feasible and acceptable. HCPs indicated that it enhanced or consolidated their knowledge and skills, covered topics relevant to their practice, and that they would recommend it to colleagues. Participants particularly valued integration of the voice of parents with lived experience in the training. Significant increase in mean scores were observed in confidence to deliver different news (2.81, 95% CI [2.43, 3.19] to 4.28, 95% CI [4.09, 4.47]; p < .001) and skills to deliver different news (3.00, 95% CI [2.64, 3.36] to 4.36, 95% CI [4.13, 4.59]; p < .001). HCPs reported feeling more confident in their ability to provide sensitive, responsive, balanced care to families. Conclusions: The significant improvements in confidence and skills reported by HCPs suggest that the training may be effective in equipping HCPs to minimize the distress, anxiety, and depression associated with receiving different news. This represents a key aspect of the prevention of mental ill health across the life course

Incorporating the interaction between health and work into the undergraduate medical curriculum – a qualitative evaluation of a teaching pilot in English medical schools

Introduction: There is a growing recognition of the impact of work on health both positive and negative. It is important that all health care professionals are equipped to understand the effects of work and worklessness on health and help patients remain in work or manage a healthy return to work where appropriate. Despite explicit reference to health and work in the General Medical Council’s Outcomes for Graduates, currently, there is not a theme that is integrated across the undergraduate medical curricula. Aim: This study evaluates medical tutors’ and undergraduates’ perspectives of a selection of health and work topics in a teaching pilot to consider the suitability and appropriateness for delivery, integration into the curriculum, tailoring of the resources, and appropriateness and expected attainment of learning objectives. Methods: Qualitative, semi structured interviews and focus groups were carried out with five medical tutors and 36 undergraduates. Interviews and focus groups were recorded, transcribed and thematically analysed. Results: The medical tutors and undergraduates identified suitability of appropriate subject specialties and years of teaching, whether learning objectives were important and if these had been achieved, and recommendations for future delivery. Discussion: Medical tutors were committed to delivering the health and work topics with the flexibility of tailoring the resources to existing subject specialties and with respect to the year of study. Learning objectives were perceived appropriate by tutors, despite ambivalence about their importance from some undergraduates. The resources were identified as having relevance to public health undergraduate teaching and teaching during general practice placements