What do the Quality Ambitions mean for Primary Care? This session describes the ongoing innovative local improvements and national work with NHS Boards and Primary Care contractors to improve quality, efficiency and outcomes as well as the future plans for Primary Care.

22. WHATS GOING ON OUT THERE? PRIMARY CARE IN SCOTLAND DR SHEENA L MACDONALD Senior Medical Adviser Scottish Government

23. The Complete Works of William Shakespeare (Abridged) By Adam Long, Daniel Singer and Jess Winfield Damien Devine and Red Lion Theatres New Red Lion Theatre Review by Simon Sladen (2011) Take 90 minutes, 37 plays, 3 actors, 1 famous bard, blitz them in a theatrical blender and what do you get? An evening of pure Shakespearean fun courtesy of The Complete Works of William Shakespeare (Abridged) .

24. WHO DO WE SEE? Estimated number of patient contacts by discipline Financial years 2003/04 to 2009/10 0 5 10 15 20 25 30 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 Financial Year Contacts [million] Health Visitor District Nurse Practice Nurse General Practitioner

29. SO WHY BOTHER? 0 500 1,000 1,500 2,000 2,500 Global Sum QoF Premises Enhanced Services Board Administered Funds Unplanned Admissions Prescribing New Outpatient attendances Direct access A&E £m Non Contracted=£3.7bn Contracted=£700m

33. Improving Patient Safety in Primary Care - The story so far Neil Houston, NHS Forth Valley

34. SUB HEADING

35. SUB HEADING

36. Safety Improvement in Primary Care (SIPC 1)

37. Aims: To enable 80 Primary Care teams to: 1.Identify and reduce harm to patients 2. Improve reliability of care for patients On High Risk Medications With Heart Failure 3.Develop safety Culture 4.Involve Patients in QI

39. 1. Reliable Care – Care Bundles 4 or 5 elements of care Evidence based Across Patients Journey Creates teamwork Done reliably All or nothing Small frequent samples

41. Bundles - Successes “ The care bundles were useful because it identified gaps” Revealing unreliable practice Indicating areas for improvement

42. 2 – Data

43. Seeing Improvement “ You can see week by week, month by month, whether or not you are showing any improvement, we seem to be improving and that’s good”

44. Tayside

45. Lothian

46. Outcome Data

47. Trigger Tools To identify and reduce harm

48. SUB HEADING

49. SUB HEADING

51. Expectations Hard to do Time Consuming Would not find harm Threatening

53. “ Seemed a bit intimidating when we first had it presented to a large group … much easier to use in practice … it’s a remarkably effective tool for reflective analysis on patient safety and other clinical issues …has created a lot of interest from other doctors in the practice as a tool for professional development and for appraisals” Doctor Gordon Cameron GP Edinburgh

54. Safety Culture

56. Insights “ Many of us in the practice staff hadn’t really made the link that us failing to communicate in was a threat to patient safety ….we had a lot of really good stuff came out of it, a lot of very open discussion”

57. Experience so Far Practices are interested Acts as a catalyst Need guidance and support Better process and report Challenges – understanding/using it /anonymity

59. Productive General Practice Susan Bishop & Mary Freel

68. The Crescent Medical Practice Patient survey response 96%

69. The Crescent Medical Practice How do staff feel about practice?

70. The Crescent Medical Practice How do staff feel about practice? 1.83 2.22 2.09 2.04 2.10 1.91 Whole Practice 0.4 0.5 0.7 0.6 0.4 0.3 Practice Management 2 2.83 2.5 2.33 2.83 2 Reception 3 3 4 3 4 4 Admin 1 3 1 1 1 1 Nurses 2.75 1.75 2.25 3.25 2.25 2.25 GPs Change And Innovation Work Life Balance Internal Comms Handling Conflict Team Working Decision Making Whole Practice Average

71. NHS Lothian’s PC Forward Group Duncan Miller General Manager, Primary Care Contracts, NHS Lothian

74. Success is a journey….. not a destination!

75. Thank you for listening Thank you for coming and participating

76. Reminder Invitation You will be most welcome to attend our Delivering Quality in Primary Care Fringe Session ...... 4:45-7pm today