Customer: Safer Salford
The Safer Salford programme is a system-wide, quality improvement focused initiative that began in 2016 in the wake of the Francis and Berwick reports (2013), and Salford’s involvement in The Health Foundation’s Safety Measurement programmes (2014a, 2014b).
As part of Safer Salford, the Safer General Practice work stream was launched in 2019. This sought to embed the use of improvement methodologies to support delivery of locally driven safety goals, such as reducing wait times, developing population health solutions and reducing harmful prescriptions. Alongside this, the work aimed to support practices to achieve the 2019/20 Salford Standard and support delivery of core elements of the NHS Long Term Plan and the 2019/20 GP contract.
All five of Salford’s Primary Care Networks (PCN) were involved, each with an improvement lead from one of the local GP practices who was equipped and enthused to test and deliver change, working within their Primary Care Network footprints. Each PCN developed a shared improvement project with an individual improvement aim for each practice.
Broughton: to reduce wait times for routine appointments
Eccles and Irlam: to reduce incidence of high blood glucose (Hba1C) for patients with diabetes
Ordsall and Claremont: to increase uptake of cytology / cervical smears
Swinton: to improve attendance for childhood asthma reviews
Walkden and Little Hulton: to reduce daily intake of morphine equivalent medications for patients on high prescriptions
Working with partners, Aqua aimed to facilitate delivery of targeted improvements whilst establishing lasting capability within primary care through the design and delivery of a bespoke training package to the PCN’s, to support GP practices with their improvement plans. Sessions were designed to provide the space and time to share and explore QI tools to develop, implement and sustain improvements in practices.
This package included improvement planning sessions and two leading for improvement sessions for each of the PCN’s. These sessions aimed to develop QI capability and running of projects, and included content around goal setting, measurement for improvement, testing changes and capturing learning. Alongside this, monthly facilitated calls were organised with neighbourhood leads to provide on-going learning and support with their improvement plans. Improvement support and guidance was also provided for individual teams, and teams were supported with the preparation and provision of materials to support improvement in primary care and neighbourhood working.
By sharing data, knowledge and best practice around how systems and processes work between different teams, aqua supported and encouraged GPs via the PCN footprint to think creatively and identify new ways to improve safety and best support their local communities and patients.
Despite the project being paused due to COVID-19, there have been a number of positive learning’s and improvements highlighted and being implemented by practices within the different PCN footprints.
At a system level those involved in the project highlighted the benefits gained from working together across the system. The approach of using PCN’s as a vehicle for improvement was the first of its kind. This demonstrated positives including stronger relationships being developed and peer support being received alongside stimulating healthy competition…
“Developing and working as a team across the network sharing ideas and resources.”
“Strong neighbourhood connections”
Working together has enabled the development of relationships, networks and support across the neighbourhoods, and has driven engagement and interest from those who previously may not have engaged. One team has now established a neighbourhood/network patient participation group, which has been set up as a result of the learning from the QI approach used throughout the project.
“Seeing improvements in patients who didn’t previously engage”
“Being able to give other team members exposure and involvement in QI and thus [engaging a] different perspective”
The work was described as an enabler.
“……. for things such as Footfall introduced online e-mail system for consultation- improving access”
[The programme] enabled “PCN discussions around digital solutions”
Communication and engagement has been recognised by the practices as key to building relationships and involving patients in the improvement project to achieve outcomes.
At an individual project level, improvements were beginning to be seen using quantitative data points and measurement for improvement. A number of examples were also seen beyond data on a chart. For example;
This work has highlighted some potentially exciting improvements. There are now real opportunities across the Salford system to further develop and build on the improvement foundations already achieved, and to sustain innovations and improvements in delivery developed during COVID-19. There is also potential for further refinement and sharing of both digital and non-digital processes and best practices developed as ‘normal work’ across the practices is resumed.
As we move forward into 2021, there may also be opportunities for further development of the programme to continue to develop QI capability, to equip staff with the knowledge and tools to feel confident in reviewing processes and best practice.
AQ: Improving Care for Patients with Sepsis in an Acute Trust
Southport and Ormskirk Hospital NHS Trust provides acute hospital services to 258,000 people across Southport, Formby and West Lancashire. Acute care is provided at Southport and Formby District General Hospital and Ormskirk and District General Hospital. Sepsis accounts for around 1,200 acute admissions to the trust each year.
AQ: Aintree Improvement Journey for Patients with Alcohol Related Liver Disease
Aintree University Hospital NHS Foundation Trust joined the Advancing Quality (AQ) programme at its launch in 2008 and is currently participating in eight clinical focus areas (CFA), this includes Alcohol Related Liver Disease (ARLD).
AQ: Reducing Avoidable Harm through Patient Assessment & Escalation
In patients who are, or become acutely unwell in hospital, there is evidence that deterioration is not always recognised or it is not acted on rapidly enough (NICE, 2007). The Walton Centre NHS Foundation Trust wanted to improve observation recording, recognition and response to deteriorating patients using the NEWS assessment tool.
AQ: Reducing Mortality in Community Acquired Pneumonia (Liverpool University Hospitals NHS Foundation Trust)
The NICE (2014) guidance publication ‘Pneumonia in Adult: Diagnosis & Management’ covers diagnosing and managing Community Acquired Pneumonia (CAP) in adults. Its aim is to improve the accurate assessment and diagnosis of pneumonia to help guide antibiotic prescription and ensure that people receive the right care. It estimates a mortality rate between 5% and 14% for patients admitted to hospital with CAP.
AQ: Serum Lactate in the Treatment of Sepsis
he Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT) identified an opportunity to improve the early diagnosis of patients with sepsis. Evidence suggests that the sickest sepsis patients have high levels of serum lactate. Timely measurement of serum lactate levels in patient pathways can improve early diagnosis which will lead to improved outcomes.
AQ: Embedding Early Assessment In Out of Hours Primary Care
Sepsis and deterioration is a huge clinical problem and 70% of sepsis cases originate in Primary Care. In the last five years we have experienced a culture shift in primary care; from seeing sepsis as an acute condition that is difficult to detect, to recognising the need to actively assess patients where infection could be causing significant illness or deterioration.
AQ: Effective Management of Frailty in Hip & Knee Replacement (Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust)
NHS England defines frailty as ‘where someone is less able to cope with and recover from accidents, physical illness or other stressful events’1. As the population ages, so frailty rates increase, presenting challenges to care systems. Elective hip and knee replacement patients undergo pre-surgical checks to ensure they are able to cope with their procedure.
AQ: Improving the Management of Acute Kidney Injury (AKI)- Role of the AKI Pharmacist
The 2009 NCEPOD report, Adding Insult to Injury, reviewed outcomes for patients with acute kidney injury (AKI) in hospital. The report found that medication was the most common AKI risk factor not assessed and only 15% of patients had their medication altered to renal doses. The national AKI programme Think Kidneys advises that medicines optimisation is essential to reduce the risk of AKI and mitigate its severity if it occurs.
Sepsis is a life-threatening condition which has in recent years become a high priority for healthcare providers. Early recognition and prompt management of sepsis can improve outcomes for patients, reducing the risk of mortality and morbidity. This could potentially save 14,000 lives and result in 400,000 fewer days in hospital for patients every year, according to estimates by the Sepsis Trust.
AQ: A Collaborative Approach to the Management of Acute Kidney Injury (AKI)
Southport and Ormskirk Hospitals NHS Trust has established a steering group to improve care for patients with AKI. The group is using the care bundle data from the Advancing Quality Alliance (AQuA) Advancing Quality (AQ) AKI programme to monitor care delivery for patients with AKI and to provide a framework for improvement.
AQ: Improving the Ultrasound Scanning Process for Patients with Acute Kidney Injury
Acute kidney injury (AKI) may sometimes be caused by an obstruction in the urinary tract, which can require treatment with a nephrostomy. It is important that people with AKI who are suspected of having a urinary obstruction receive an ultrasound scan early in their management, as outlined in national guidance (NICE, 2019).
AQ Insight Reports: Case Study
More patients are admitted to hospital as a result of pneumonia in the north of England compared to the south. In the North West in 2019, the rate per 10,000 population was 58.5. To help reduce unwarranted clinical variation and health inequality, capture best practice and share evidence-based insights to AQ members across the North West, the AQ team created ‘Insight Reports’.