Cohort B – Year 1

The way we approached the improvement project had the Model for Improvement at its core. As I mentioned, it’s really tempting to begin with a solution in mind. The rigour of asking the questions in the right order can make a big difference to the project.

http://www.ihi.org/education/ihiopenschool/Courses/Documents/QI102-FinalOnePager.pdf

Why is this a problem? We used an Ishikawa diagram to look at the root causes of our problem. There are other techniques if you don’t like this one. I’ve given two references – the first is not health specific and I like the explanation but the second might help because it gives a healthcare example.

https://www.moresteam.com/toolbox/fishbone-diagram.cfm

https://qi.elft.nhs.uk/resource/cause-and-effect-diagram-fish-bone/

Another way of understanding what is going on is Process mapping which is, essentially, a flow chart for a repeating process. We can then look to improve the process by making it cheaper, safer, a better experience for patients or a higher quality service. Hopefully we may get a chance to play with these at some point as they’re incredibly useful, especially for getting others involved.

https://qi.elft.nhs.uk/resource/flow-diagrams/

Ideas generation I can’t find a good reference for this. I think the process summarised in the slide deck is enough! If you’re interested in the topic, here is an interesting podcast about creative thinking in groups

https://www.ted.com/talks/worklife_with_adam_grant_the_daily_show_s_secret_to_creativity

We can then use a Prioritisation Matrix to help decide what we’re going to try first. There are other tools but this is lovely and simple.

https://learn.nes.nhs.scot/3981/quality-improvement-zone/qi-tools/prioritisation-matrix

Testing (PDSA cycles) Is ‘the engine’ of QI. The key things to appreciate are:

  • Start small, test with one person for a short time
  • Qualitative feedback might be key at the start
  • (You may want to PDSA your data collection, for example)
  • The P stands for PLAN – plan how you’re going to run the test (not the whole change project)
  • The A stands for ACT – what are you going to do next. Often it will be another PDSA cycle with a tweak. Eventually, hopefully, it will be…implement i.e. it’s good enough to use for the whole practice

https://qi.elft.nhs.uk/resource/the-pdsa-cycle/

Measuring and displaying data (run charts) – don’t forget the power of sequential data. If you measure the same variable 25 times in a row, the chart you generate will give you very high statistical certainty (>98%) about whether what you see is ‘common cause’ (random) variation or ‘special cause’ variation.

https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/A-guide-to-creating-and-interpreting-run-and-control-charts.pdf

The session will be delivered by Dr Ellen Fallows along with Dr Rupa Joshi and Helen Longstaff.

Dr Ellen Fallows is a GP with a portfolio career and interest in Type-2 diabetes remission and obesity management through behaviour change and person-centered care. She was a GP partner in Bicester for 10 years where she set up face to face group clinics. She now practices at Brackley Medical Centre where she is setting up video group clinics having already delivered groups for Type-2 diabetes remission locally.  She is also working with a team delivering video group low calorie diet replacement as part of the NHS Type-2 Diabetes remission pilots and with the British Society of Lifestyle Medicine as their learning academy lead.

Ellen is the NHS England Clinical Lead, Virtual Group Consultations, Thames Valley Health Education England GP Fellow, RCGP Person Centred Care Lead, South East, Trustee and Learning Academy  Director, British Society of Lifestyle Medicine

Dr Rupa Joshi has been a front-line GP for 19 years and Managing Partner for 5 years and is Co-Clinical Director for Wokingham North Primary Care Network, Workforce lead for Berkshire West, Faculty GP for the ‘Time for Care’ Programme for NHSE/I and Co-Chair of the South East Region for NHS Confederation PCN Networks.

Dr Joshi has been delivering face to face Group Consultations since 2018 and now Virtual Group Consultations throughout the pandemic to ensure patients are able to consult with trusted colleagues. She has also rolled out webinars and VGCs for her PCN working with a Multidisciplinary team.

Dr Joshi is also a Certified Lifestyle Medicine Physician BSLM/ IBLM and Accredited Coach ILM-5.

Learning Objectives for this session:

  1. Be able to describe the group consultation process to patients and staff in primary care
  2. Be able to state the session flow of a group consultation
  3. Be able to list the roles required to set-up group consultations
  4. Describe the key issues with working in groups in a virtual space (ID, consent, confidentiality, cybersecurity)
  5. Be aware of the free resources to support delivery of video group clinics
  6. Describe the areas where group consultations can be used to deliver care, in particular their use in chronic disease annual reviews and to address the back-log in this care as a result of covid-19
  7. List the benefits of group consultations for patients and staff in particular addressing issues such as person-centred care, supported self-care, social isolation, integration of the additional roles in primary care
  8. Explore the risks, barriers to implementation and challenges around group consultations delivered both virtually and face to face. Consider these in the context of participants own work-load and their practice set-up.
  9. Explore ways to over-come barriers to implementation and how to engage local stake-holders to support projects to deliver group consultations in practice (including learning about how to make a business case for group consultations)
  10. Understand the impact of group consultations on patients (including hearing a patient testimonial)

Pre-session information:

Watch these clips on what virtual group consultations are all about: https://vimeo.com/483179581

https://www.groupconsultations.com/virtual-group-consultations/

Hear from a GP who has delivered face to face group consultations: https://youtu.be/He36c4BD4Hw

Post Session Resources

Free e-learning and tool-kit:

https://www.e-lfh.org.uk/ (register with NHSmail account and search for “video group clinics”)

Books

The Community Cure: Transforming Health Outcomes Together by James Maskell, 2019, Lion crest publishing

How to facilitate lifestyle change. Applying group education in healthcare. Amanda Avery, Kirsten Whitehead and Vanessa Halliday, 2016, Wiley-Blackwell

The ABCs of Group Visits. An Implementation Manual for your Practice. Edward B Noffsinger, 2013, Springer

Running Group Visits in your practice, Edward Noffsinger, Springer

Websites

Case studies: https://www.redmoorhealth.co.uk/video-group-clinics/

International experience: https://bslm.org.uk/vgc/

www.elcworks.co.uk

www.groupconsutlations.com

www.bslm.org.uk

www.lifestylemedicine.org.au/shared-medical-appointments

www.healthylondon.org/resource/primary-care-children-young-peoples-toolkit/education-workforce/group-consultations

www.rcgp.org.uk/clinical-and-research/resources/bright-ideas/shared-medical-appointments-in-the-uk-dr-rob-lawson.aspx

www.primarycaresheffield.org.uk/cases/shared-medical-appointments

ellen’s VGC quick guide

http://primarycarecareers-bob.nhs.uk/wp-content/uploads/2021/05/Ellens-Handout-for-GP-Fellowship-on-Group-Consultations.pdf

BOB fellowship CPD 27th April

Lesley Simpson: National Dip. Health and Fitness, BACPR Clinical Exercise Specialist, PGCE, RSA, TDLB 32/33, HPD, NCH, Making Every Contact Count (MECC) super trainer, Year of Care trainer

Until her recent retirement, Lesley worked with Bucks and Oxfordshire Clinical Commissioning Groups to oversee the delivery of the Year of Care, Care and Support Planning (CSP) initiative. The CSP scheme is intended to provide more personalised support for patients with long term conditions to help them to manage their health better. Working with the practices, GPs and Practice nurses it was her role to develop and deliver personalised care training, develop resources and support quality development of the scheme across Bucks and Oxfordshire CCG area.

Currently Lesley is working with Oakwood Wellbeing as part of a team of therapists who are tasked with developing and delivering a Long COVID rehabilitation programme. This course has recently been piloted and the results of the evaluation are expected to be positive.

Previously she has worked as part of a multi-disciplinary team and was the clinical exercise lead for the Janssen Health Care Innovation “Care4today Heart Healthcare” research programme. Janssen Health Care Innovation were working in partnership with Buckinghamshire Healthcare Trust to execute a study designed to determine if short term and long term interventions improve prognosis and reduce readmissions.

Lesley has been involved, since its conception, with the British Association of Cardiac Prevention and Rehabilitation (BACPR) education and training development team and is an Internal Verifier for their courses. She is a BACPR Course Director and sits on the BACPR Education Steering Committee.

Lesley develops and delivers bespoke training courses for exercise specialists and health professionals which focus on linking the importance of supporting behaviour change to the health benefits of  being more physical activity

In recent years she has achieved further qualifications in Person Centred Therapy, Cognitive Hypnotherapy, Anger Management and is currently working towards the Life Coaching Diploma.

Dr Katherine Mollart is a Consultant Clinical Psychologist. She holds a Doctorate in Clinical Psychology from Oxford University. She is a registered Practitioner Psychologist with The Health Care Professional Council (HCPC), which monitors and regulates the practice of Clinical Psychologists. She is a Chartered Clinical Psychologist with The British Psychological Society (BPS) and an accredited CBT therapist with the British Association of Behavioural Cognitive Psychotherapies (BABCP).

Dr Mollart practiced in the NHS for 12 years and worked as the Deputy Clinical lead for a London Improving Access to Psychological Therapies (IAPT) service. In her NHS role she specialized in working with patients with long-term physical health problems such as chronic pain, chronic fatigue and diabetes. As part of this work, she provided consultation, supervision and training to therapists and other healthcare professionals, including GPs and consultants.

Dr Mollart became a Year of Care trainer for the Thames Valley in 2014, alongside her NHS role.

Dr Mollart founded Mollart CBT Ltd in 2016, a private practice offering psychological therapy to adolescents, adults and couples. She now works as Mollart CBT’s Clinical Director full-time and continues to enjoy her role as a Year of Care trainer.

This half day workshop delivered by Dr Rachel Morris will show you how to use some of the Shapes Tools to help delegates take more control over their own responses and behaviour, understand the responses and motivations of other people and have a greater impact in their workplace and influence others in ways that create win-win solutions for everyone.

 

By attending this session, delegates will be able to:

  • Identify how they are reacting and responding to particular situations and then behaving in ways that are unhelpful
  • Identify the thoughts and stories in their heads that are holding them back
  • Understand why others may respond negatively to change and to suggestions
  • Understand how others may be motivated and use different ‘currencies’ to influence stakeholders
  • Be able to listen and be empathetic to others interests and needs in order to come up with a win-win solution
  • Understand the importance of building trust with colleagues and stakeholders

This session will be led by Dr David Griffiths who we met previously on our Introduction to QI session.

Session objectives: to embed and extend the learning from our previous session to enhance the choices available to you in QI project work (and to have fun)

 

  • Recap previous session – an opportunity to ask questions about the core QI skills covered last time
  • Aim statements – a few more tips re writing impactful aim statements
  • Measurement – building on last time, more info about measurement for improvement: types of measures / how to measure effectively
  • Creativity techniques – how to have more and better ideas – an introduction to a couple of techniques to increase the diversity of your thinking and then assess the ideas you’ve had

 

We would like you to come to the session prepared with a project in mind for the second year. This is something you will lead in your practice/PCN and should therefore be something your practice/PCN would like to see improve. Some ideas of the types of projects you could consider are;

  • Improving the appointment system
  • Increasing COVID vaccine uptake particularly in the most vulnerable
  • Medication safety systems in the practice/PCN
  • Setting up/improving the patient participation group
  • Reducing anticholinergic prescribing
  • Integration and support  of ARRS (allied health professionals) across the PCN

We have also a pdf with some other ideas. https://primarycarecareers-bob.nhs.uk/wp-content/uploads/2021/07/Project-examples-for-Year-2.pdf

If you are unable to make this session (and we know some of you are on holidays) we will attempt to record it, to help you begin to plan for your project.

Launch Event for Cohort C who will be joined for next 6 months with Cohort B – getting to know each other and the team. Informal session running from 2pm until around 4pm.

This event will be a face to face event held at  Lambert Hotel in Watlington https://all.accor.com/hotel/A7X1/index.en.shtml?utm_campaign=seo+maps&utm_medium=seo+maps&utm_source=google+Maps

 

This session will be an introduction to the BOB Integrated Care System, HEE and other related organisations and how these can support you as you progress in your career.

This session will be split into GPs and GPNs (as they speakers will be slightly different for each role).

This session is led by David Griffiths

 

 

The session is lead by Clare Hodson.

This session will be a face to face session held at the Mercure  Thame Lambert Hotel ,London Road, Aston Rowant, Watlington OX49 5SQ.

 

A gentle reminder to  take a lateral flow test, we also ask that you wear a face mask during the CPD session.

We look forward to seeing you all.