Progress of GP clusters 2 years after their introduction in Scotland: findings from the Scottish School of Primary Care national GP survey.

Stewart Mercer,Bridie Fitzpatrick,John Gillies

doi:10.3399/bjgpopen20x101112

Stewart Mercer, Bridie Fitzpatrick + Show 1 more

Open Access

https://doi.org/10.3399/bjgpopen20x101112

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Journal: BJGP open	Publication Date: Nov 3, 2020
Citations: 13	License type: cc-by

Affiliation: University of Edinburgh, University of Glasgow

Abstract

BackgroundThe concept of GP clusters is derived from 'quality circles' in general practice in Europe and Canada. GP clusters commenced across Scotland in 2016 to improve the quality of care of local populations.AimTo determine GPs' views on clusters, and the robustness of bespoke questions about them.Design & settingA cross-sectional national survey of work satisfaction of GPs in Scotland took place, which was conducted in July 2018–October 2018.MethodAn analysis of bespoke questions on GP clusters was undertaken. The questions were completed by quality leads (QLs) and all other GPs in a nationally representative sample of GPs.ResultsIn total, 2456 responses were received from 4371 GPs (56.4%). QLs reported that clusters were meeting regularly, and were friendly and well organised but not always productive. Support for cluster activity (data, health intelligence, analysis, quality improvement methods, advice, leadership, and evaluation) was suboptimal. Factor analysis identified two separate constructs (cluster meetings [CMs] and cluster support [CS]), which were minimally influenced (<2%) by GP and practice characteristics. Non-QLs (75% of all GPs) were generally satisfied with the two-way communication with the cluster QLs, but the great majority (>70%) reported no positive changes in various aspects of quality improvement. Factor analysis of these items indicated two constructs (cluster knowledge and engagement [CKE] and cluster quality improvement [CQI]), which were minimally affected by GP and practice characteristics.ConclusionGP clusters are ‘up and running’ in Scotland but are at an early stage in terms of perceived impact and appear to be in need of more support in order to improve quality of care. The bespoke questions developed on clusters have robust construct validity, suitable for future surveys.

Highlights

GP clusters were introduced nationally in Scotland in April 2016, following the termination of the Quality and Outcomes Framework (QOF) and the initiation of transitional quality arrangements.[1]
The bespoke questions developed on clusters have robust construct validity, suitable for future surveys
GP clusters or 'quality circles', as they are known in Europe, have been shown to improve various aspects of quality of care in general practice, Scotland is one of very few countries to introduce them on a compulsory and national scale

Summary

Introduction

GP clusters were introduced nationally in Scotland in April 2016, following the termination of the Quality and Outcomes Framework (QOF) and the initiation of transitional quality arrangements.[1] In Scotland, clusters are geographical groupings of GP practices, which aim to improve quality of care within and across practices (intrinsic role), and to contribute to health and social care integration (extrinsic role).[2,3] Each cluster has a GP cluster quality lead (CQL) and each practice has a GP practice quality lead (PQL) who attends the CMs. Clusters are formed by groups of GP practices who choose to work together and are responsible for their own governance via their own professional responsibilities (‘peer-led, values driven’).[1,2] CQLs, are part of a ‘tripartite’ arrangement with the local NHS health board and the local GP subcommittee of the Area Medical Committee (see Supplementary file for further details). GP clusters commenced across Scotland in 2016 to improve the quality of care of local populations

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