RT Journal Article
SR Electronic
T1 Collaborative improvement in Scottish GP clusters after the Quality and Outcomes Framework: a qualitative study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e719
OP e727
DO 10.3399/BJGP.2020.1101
VO 71
IS 710
A1 Huayi Huang
A1 Emily R Jefferson
A1 Mark Gotink
A1 Carol Sinclair
A1 Stewart W Mercer
A1 Bruce Guthrie
YR 2021
UL http://bjgp.org/content/71/710/e719.abstract
AB Background Scotland abolished the Quality and Outcomes Framework (QOF) in April 2016, before implementing a new Scottish GP contract in April 2018. Since 2016, groups of practices (GP clusters) have been incentivised to meet regularly to plan and organise quality improvement (QI) as part of this new direction in primary care policy.Aim To understand the organisation and perceived impact of GP clusters, including how they use quantitative data for improvement.Design and setting Thematic analysis of semi-structured interviews with key stakeholders (n = 17) and observations of GP cluster meetings (n = 6) in two clusters.Method This analytical strategy was combined with a purposive (variation) sampling approach to the sources of data, to try to identify commonalities across diverse stakeholder experiences of working in or on the idea of GP clusters. Variation was sought particularly in terms of stakeholders’ level of involvement in improvement initiatives, and in their disciplinary affiliations.Results There was uncertainty as to whether GP clusters should focus on activities generated internally or externally by the wider healthcare system (for example, from Scottish Health Boards), although the two observed clusters generally generated their own ideas and issues. Clusters operated with variable administrative/managerial and data support, and variable baseline leadership experience and QI skills. Qualitative approaches formed the focus of collaborative learning in cluster meetings, through sharing and discussion of member practices’ own understandings and experiences. Less evidence was observed of data analytics being championed in these meetings, partly because of barriers to accessing the analytics data and existing data quality.Conclusion Cluster development would benefit from more consistent training and support for cluster leads in small-group facilitation, leadership, and QI expertise, and data analytics access and capacity. While GP clusters are up and running, their impact is likely to be limited without further investment in developing capacity in these areas.