NHS QIS Strategy for Primary and Community Health

Care Services

Jan WarnerDirector of Patient Safety & Performance Assessment

• established January 2003 by the Scottish Parliament

• merger of six quality improvement organisations

• special health board - independent in its advice, assessments and recommendations

NHS QIS

• gathering, appraising and providing evidence• translating evidence into practice • setting standards• reviewing performance• providing guidance on effective clinical practice• co-ordinating and promoting patient safety

(Institute of Medicine – 6 domains of quality)

‘Making it easier to do the right thing’ by

Why?

NHS QIS (and its predecessor organisations) has focused mainly on secondary care

BUT• 90% of care is provided in community and primary

healthcare services• 27.4 million patient contacts with members of

medical practices in Scotland (2005)• Delivering for Health, and the drive to shift the

balance of care from hospital settings into the community

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

How?

• Appoint Primary Care Advisor (Dr Malcolm Kerr)

• Commissioned work to map existing pchc quality initiatives across NHS Scotland

• Meetings held with representatives from NHS Boards, Special Health Boards, SEHD, Scottish Consumer Council to test validity of themes emerging from discussions

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

Consultation

• Draft strategy and work programme widely circulated for consultation (over 500)

• Meetings held with a number of Boards and Community Health Partnerships

• Excellent response with strong support for the principles of the strategy (over 80)

But….

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

Overarching Principles (1)

• Person-centred, working in partnership with patients, public and carers

• Aligned with the strategic direction and policy thrust of Delivering for Health

• Reflect NHS Board accountability

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

Overarching Principles (2)

• Work collaboratively with all organisations involved in health and social care

• Build on existing models, networks, expertise and intelligence

• Proportionate, risk based and take account of best available evidence

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

Aims of the strategy (1)

• Improve the quality of primary care by being a trusted and credible source of knowledge

• Improve patient safety by using available data to address variations in practice and learning from past experiences

• Promote the best possible clinical care through the development and dissemination of clinical guidelines, standards and best practice statements

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

Aims of the strategy (2)

• Support and encourage staff in improving services through networks, practice development and the translation of evidence into practice

• Support NHS Boards in the review and monitoring of performance to determine how well NHS services are performing against the standards set

* The ‘unit of measurement‘ will be at NHS Board or CHP level, not individual practitioners

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

Strategic Objective 1

Improved quality of care and patient safety in community and primary healthcare services

Rationale

About one in ten people using the NHS will experience an adverse incident, of which at least 50% are potentially avoidable. As over 90% of care is provided out with hospitals, improving patient safety is critical.

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

Examples of current projects

Pilot project on Implementing the NPSA Seven Steps to Patient Safety in General Practice

A web-based tool for comparative analysis of medical practice data to identify variation in practice, based on commonly used clinical indicators

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

Strategic Objective 2

The implementation of clinical guidelines, standards and best practice statements – translating evidence into practice to continually improve clinical care

Rationale

Guidelines, standards, indicators and best practice statements provide a framework for continuous improvement in the overall quality of care people receive

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

Examples of current projects

Key Performance Indicators for unscheduled care, covering NHS24, Out of Hours centres, the Scottish Ambulance Service and Emergency Departments

Support roll out of the Scottish Woman Held Maternity Record (SWHMR)

Standards for the Integrated Care Pathways under development for mental health services (schizophrenia, bi-polar disorder, personality disorder, dementia and depression)

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

Strategic Objective 3

Monitor the performance of NHSScotland. The ‘unit of measurement‘ will be at NHS Board or CHP level, not individual practitioners

RationaleThe ability to measure the quality of services is essential for successful implementation of a culture that supports clinical governance. Performance assessment enables NHS QIS to evaluate what NHSScotland is doing and how well services are performing

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

Examples of current projects

External quality assurance of how NHS Boards implement the GP appraisal process

Work with Scottish Executive to develop external quality assurance of NHS Boards’ arrangements for monitoring community pharmacy services

Assessment of NHS Boards’ performance against standards for emergency dental services (EDS)

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy

What next?

• Publication of strategy & work programme Oct ‘07

• Consultation on future projects

• Workshop this afternoon – Dr Malcolm Kerr

Shifting the Focus: NHS QIS Community and Primary Health Care Services Strategy