General Practice Quality Improvement Evaluation

The overall aim of this evaluation is to develop insights about the organisation, commissioning and delivery of quality improvement programmes targeted at improving access to general practice in a way that meets diverse local priorities and population needs.

Background

Demand and patient complexity in general practice are increasing, and practices are facing a widening gap between this demand for consultations and the capacity available to meet it. Changes in the 2023/24 GP contract and publication of the NHS England ‘Delivery plan for recovering access to primary care’ have created a national policy push for quality improvement in general practice focussed on access.

Various quality improvement programmes and offerings have been made available to support GP practices; these include the NHS England General Practice Improvement Programme (GPIP) and the Quality and Outcomes Framework (QOF) Quality Improvement (QI) project.

However, little is known about the implementation of policies on access through quality improvement programmes, their alignment with local priorities and improvement programmes, and the role of regional stakeholders in supporting both national policy implementation and local improvements in GP practices. Integrated Care Boards (ICBs) are organised to meet the health needs of people in a specified geographical area as well as supporting improvement programmes in general practice. Yet their role and responsibilities in respect of commissioning and supporting general practice provider service improvement remain relatively under-specified.

Approach

The evaluation will consist of four work packages (WP):

WP1: Identifying stakeholders

Mapping relevant literature and working with the BRACE Service Leaders’ panel to identify stakeholders at the ICB level to establish an Advisory Group to support the evaluation team with insights into the ongoing organisation of ICBs.

WP2: Experiences of national stakeholders

We will interview 10-15 individual stakeholders to understand what is currently working well and what is needed for ICBs, in partnership with GP practices and primary care networks, to build capacity for, develop and support quality improvement activities.

WP3: Qualitative case study work

We will select four ICB region case studies to explore in-depth how general practice quality improvement programmes are understood and experienced locally by stakeholders at ICB, primary care network and GP practice levels. We will interview stakeholders, including primary care and quality improvement leads at ICBs and primary care networks, GP partners, practice managers, salaried GPs, practice nurses and other clinical and administrative staff involved in or impacted by quality improvement (N=10-12 interviews per case study site). We will also conduct focus groups with GP practice patient participation groups (N=1-2 focus groups per case study site) and review local policy documents and reports about the quality improvement programmes. To a gain a wider breadth of understanding of stakeholder experiences we will supplement the interviews with an online survey with bespoke questions for each stakeholder group.

WP4: Analysis, synthesis and sharing of learning

We will draw on relevant theories and frameworks, such as assemblage thinking and concepts such as power, resistance and opinion leaders, in our analysis to develop insights within and across case studies. Two online workshops will be held to rapidly test and refine findings, one workshop with NHS England, ICB leads, GPs and selected members from the BRACE advisory panels and another workshop with stakeholders from each case study site.

Project team

  • Judith Smith (Co-PI)
  • Manni Sidhu (Co-PI)
  • Frances Wu
  • Sophie Spitters

Outputs

Results from this evaluation project will be written up in a report and published in the NIHR Journals Library (HSDR programme), and we will also share findings in a number of alternative formats (such as presentations, blog posts, or infographics) to reach multiple audiences.

Project Duration

July 2024 - June 2025