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Some years ago I was approached by a group of local GPs who wanted to apply for CCG support for an improvement idea.  They wanted to improve the flow of their elderly (>70 years) patients through the unscheduled care stream of our local acute hospital.  And they recognised that they needed to develop their improvement skills to do it.  So started the ACE project and what we learned was surprising, and delighting and alarming. My job was improvement science coach – they did the hard work.

What they showed was that by re-designing some of their primary care processes, they could have a big impact on the experience and outcomes of elderly patients admitted as emergencies.

And what they learned was how to do this in a scientific, logical, rational and enjoyable way using a tried-and-tested framework called HCSE (health care systems engineering).

And they wrote up their story and published it (attached), and kept doing what they had demonstrated had worked for their patients and themselves.

Recently they approached me again to assist with evaluating the longer-term evidence, and I was very happy to help because I too was curious to learn if their improvements had sustained. They had.

This is the acid test of any effective improvement method:
(a) can it be learned and applied by the people who live the process and
(b) are there significant improvements on all dimensions – safety, flow, quality and value-4-money and
(c) are the improvements self-sustaining.

And it appears that the HCSE approach works just as well in primary care as it does in secondary care.

The next BIG challenge is Primary Care Access … i.e. eliminating the chaos and stress associated with delivering the highest footfall service in the NHS with 1,000,000 appointments per day in England.

The good news is that it looks like this “wicked problem” is also amenable to the improvement-by-design approach but only if the people who own the process i.e. GPs, practice nurses, receptionists and practice managers learn how to do it themselves.

So that is my question … is there anyone in the Q Community Primary Care SIG who is willing to have a go?