Clinical audit in commissioning

The Health care Quality Improvement Partnership has published Using Clinical audit in commissioning healthcare services.

This guide outlines how clinical audits can be used by commissioners to assure both quality and drive continuous improvement in patient care. It examines the strengths and limitations of clinical audit outputs for monitoring and assurance as well as considering how clinical audit can drive quality improvement as demonstrated through case studies and practical guidance.

Early benefits of delegated commissioning

NHS England have produced a series of Delegated commissioning case studies to show how CCGs are using delegated commissioning to improve care for local people. 

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CCGs have reported that delegated commissioning is leading to:

  • The development of clearer, more joined up visions for primary care, aligned to wider CCG and STP plans for improving health services;
  • Improved access to primary care;
  • Improved quality of care being delivered to patients;
  • Improved CCG relationships with member practices, including greater local ownership of the development of primary care services;
  • Increased clinical leadership in primary care commissioning, enabling more local decision making;
  • Greater involvement of patients in shaping services;
  • A more sustainable primary care system for the future.

NHS England have produced a series of case studies to show how CCGs are using delegated commissioning to improve care for local people:

National health organisations publish a shared commitment to quality

The National Quality Board (NQB) has today (21 December) published a new framework that will promote improved quality criteria across all national health organisations for the first time | NHS England

shared-quality

Image source: NHS England

The new publication provides a nationally agreed definition of quality and guide for clinical and managerial leaders wanting to improve quality.

The approach has been agreed by the national bodies that form the NQB to provide more consistency and to enable the system to work together more effectively.

It is part of work to cut unnecessary red tape by reducing duplication and aligning demands on professionals for information on the quality of services.

The document sets out a range of measures to achieve higher and consistent standards including: the need for a common language that people who use services understand; to ensure commissioners and providers experience a coherent system of assurance, measurement and regulation; that professionals and staff are equipped and empowered to deliver safe, effective, and responsive care; and leaders should create a culture where people feel free to speak up when something goes wrong.

Read the full overview here

Read the full framework here

New NHS leadership framework

New NHS leadership framework – Developing people improving care | NHS England

NHS England and NHS Improvement have been working with the other health Arms Length Bodies (ALBs) to develop the new NHS leadership framework – Developing people improving care.

This is an evidence-based national framework to guide action on improvement skill-building, leadership development and talent management for people in NHS-funded roles.

The framework focuses on helping NHS and social care staff to develop four critical capabilities:

  • systems leadership for staff who are working with partners in other local services on ‘joining up’ local health and care systems for their communities
  • established quality improvement methods that draw on staff and service users’ knowledge and experience to improve service quality and efficiency
  • inclusive and compassionate leadership, so that all staff are listened to, understood and supported, and that leaders at every level of the health system truly reflect the talents and diversity of people working in the system and the communities they serve
  • talent management to support NHS-funded services to fill senior current vacancies and future leadership pipelines with the right numbers of diverse, appropriately developed people

Read more about the framework on the NHS Improvement website.

Quality and Outcomes Framework (QOF) – 2015-16

Summary

This Quality and Outcomes Framework (QOF) publication provides data for the reporting year 1 April 2015 to 31 March 2016. The QOF was introduced as part of the new General Medical Services (GMS) contract on 1 April 2004. The objective of the QOF is to improve the quality of care patients are given by rewarding practices for the quality of care they provide to their patients. The Calculating Quality Reporting Service (CQRS), together with the General Practice Extraction Service (GPES) were used for the extraction of QOF data. There have been changes to QOF coding and indicators. These are referred to throughout this publication. Consideration must be given to changes to indicators and their definitions each year when interpreting differences and comparing data from one year to the next.


Key facts

  • QOF recorded prevalence – Recorded prevalence for 2015-16 is presented for 7,619 general practices in England.
  1.  The highest prevalence rates are for Hypertension (13.8 per cent), Obesity (9.5 per cent) and Depression (8.3 per cent).
  2. Hypertension (7.9 million), Obesity (4.3 million) and Depression (3.8 million) are the conditions reporting the highest register numbers.
  3. The largest year on year differences in register numbers are in Depression (increase of 470,168) and Obesity (increase of 132,222).
qof

Image source: NHS Digital

  •  QOF achievement  – Achievement data for 2015-16 shows that:
  1.  The average achievement score for practices was 532.9 points out of 559
  2. The highest levels of achievement were for Obesity and Chronic Kidney Disease where 99.9 per cent was achieved. The lowest level of achievement was in Osteoporosis at 87.5 per cent.
  3. 640 practices achieved the maximum of 559 points. In 2014-15 there were 448 practices which achieved the maximum of 559 points.
  •  QOF exceptions – Exceptions data for 2015-16 show that:
  1.  The condition with the highest percentage of exceptions is Cardiovascular Disease at 31.3 per cent overall
  2. The measure with the lowest percentage of exceptions is Blood Pressure at 0.5 per cent overall.

Read the full overview here

Read the full report here

Four tools to enhance significant event analysis in primary care

The Health Foundation | Published online 25 August 2016

Significant event analysis (SEA) is a collective learning technique used to investigate patient safety incidents (circumstances where a patient was or could have been harmed) and other quality of care issues.

The project developed a framework and then a series of practical tools, which aim to help people working in primary care to apply the approach.

1. E-learning module

This short ‘read and click’ e-learning module is available as a PDF from the Quality Improvement Hub. It explains and illustrates the principles which underpin the enhanced SEA approach, including sections on: Basic error theory; Human factors principles; Taking a systems-centred approach; and the Enhanced SEA method.

2. Enhanced SEA booklet

The enhanced SEA booklet (PDF), developed by the project team, gives a clear, readable overview of the approach, including the basics of human factors theory and an example story. It aims to help individuals reflect on the potential emotional impacts of a significant event by using these principles to gain a clearer understanding of all of the contributory factors involved.

toolkit

Image source: The Health Foundation

3. Deskpad

In addition to individual reflection, it’s important that teams reflect together on events and analysis. Each sheet of this enhanced SEA deskpad (PDF) contains instructions and prompts to help guide a team in taking this approach to event analysis, and to take notes on what was agreed.

4. Reporting template

The project team also designed and developed a new report format (PDF) for writing up SEAs, which accommodates this approach. This format is recommended for GP specialty training and medical appraisal, as well as for practice manager and nurse vocational training and appraisal.  It is also being used in community pharmacy and dental practice in Scotland.

Read the full project overview here

 

Case study: Outstanding, safe care for all

Care Quality Commission

Inclusion Healthcare provides primary medical services for homeless people in Leicester. It was rated outstanding following its CQC inspection in November 2014. CQC inspectors found strong leadership at its heart and a positive culture that ensures patient safety is paramount. CQC went back to the practice to talk to some of its staff and find out more.

View the full case study here