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Diagnose

Organisational development – reproduced from original image © NHS Photo Library

Having understood your culture and context, you can undertake a diagnosis to identify areas of practice that could
 be improved or would benefit from change.

This section contains a variety of tools that support effective diagnosis. You can choose to use one tool or several together. We have grouped them into analysis tools, external data and new data.

  • GM gastroenterology GP education webinarThe Greater Manchester gastroenterology GP education webinar was held on the 24th September 2020 and introduced participants to the updated endoscopy referral pathways. Presentations, questions and answers and a recording of the webinar are available to download and watch.
  • Guidelines for managing patients with dyspepsia in primary careDyspepsia is a term that describes a collection of symptoms that affect the oesophagus (gullet), stomach or duodenum (the first part of the small intestine). This pathway provides guidance on managing patients with dyspepsia in primary care.
  • Getting Into Research – online workshopThe GM GP Excellence Programme, in conjunction with the National Institute for Health Research (NIHR) Clinical Research Network Greater Manchester, invite those working in Primary Care to an online workshop on 24th September 2020 from 2:30-4pm to consider becoming research active - providing opportunities for your patients and team to play a part in research and innovation.
  • The Primary Care Knowledge Boost Podcast – Fibromyalgia Part 2In this podcast, Lisa and Sara discuss the management of fibromyalgia in general practice with Professor Anthony Jones and Consultant Physiotherapist William Gregory.
  • COVID-19: Episode 9: Suspected Cancer During COVID-19In this podcast Lisa and Sara speak with Dr Sarah Taylor and Dr Viren Mehta about the challenges in general practice at the moment in assessing and investigating patients for suspected cancer symptoms.
  • Quality improvement: prescribing and patient safety reportsThe RCGP and Clinical Practice Research Datalink (CPRD) have developed confidential bespoke practice and patient-level drug prescribing reports, available for free for GP practices contributing to CPRD.
  • QOF Quality Improvement (QI) Modules – What’s it all about?The idea behind introducing ‘QI Modules’ rather than targets is that practices can be flexible and, mostly, work on a project that is specific to their patient needs, aiming towards an outcome that is valued by the patients and the practice, and using sound QI methods.
  • Clinical research in primary careIn this video members of the Clinial Research Network for Greater Manchester explain the wide-ranging benefits of carrying out clinical research in the primary care setting of GP practices and pharmacies.
  • Time for Care Quality Improvement for General Practice NursesTime for Care Quality Improvement for General Practice Nurses is a two day programme designed for all nurses working in general practice across North West and North East England.  
  • COPD – Greater Manchester COPD ProgrammeHealth Innovation Manchester is bringing together resources from the NHS, social care and pharmaceutical industry to ensure that every person with Chronic Obstructive Pulmonary Disease (COPD) has access to equitable, high quality care. This clinician-led learning tool aims to support local GP practices in the care of patients with COPD.2 comments
  • The NHS AppThe NHS App enables people to check their symptoms using the health A-Z on the NHS website and to find out what to do when they need help urgently using NHS 111 online. The NHS app will be available to all patients across Greater Manchester in the coming weeks.
  • Productive General Practice programmeThe Productive General Practice programme is designed to help general practice continue to deliver high quality care whilst meeting increasing levels of demand and diverse expectations.
  • Quality Improvement to drive earlier cancer diagnosisCancer Research UK and Dr Bill Taylor (RCGP Clinical Lead for building QI capability) invite you to attend a half day workshop focused on using quality improvement techniques to drive the early diagnosis of cancer in primary care.
  • Time for Care learning in action programmeThe Time for Care programme is at the heart of the General Practice Forward View's support for practices to redesign their care and manage demand more sustainably. Using a variety of means this initiative provided by the NHS England Sustainable Improvement team will give every practice in England the chance to learn about proven innovations that release time for care.
  • Productive General Practice Quick StartProductive General Practice (PGP) Quick Start is an on-site, hands-on, short term support package for practices that forms part of a local Time for Care programme. Alongside the 10 High Impact Actions the support package provided by NHS England’s Sustainable Improvement team aims to help practices release time for care and build improvement capability.
  • General Practice Improvement Leaders ProgrammeThe General Practice Improvement Leaders Programme is a free training programme designed for GPs, practice managers, nurses, project managers and facilitators working in general practice to support the GP Forward View. The programme provided by NHS England’s Sustainable Improvement team offers step-by-step tools and techniques to help build skills and confidence to lead service redesign in general practice.
  • e-Learning for Healthcaree-Learning for Healthcare offers an extensive catalogue of e-learning programmes that enhance traditional learning, support existing teaching methods and provide a valuable reference point which can be accessed anytime, anywhere.
  • Life QIThe Life QI online platform is a project and programme management tool for quality improvement, using quality improvement approaches and techniques.
  • Healthcare hackathonsThis resource explains how the Innovation Agency, the Academic Health Science Network (AHSN) for the North West Coast, can help local healthcare organisations to run their own hackathons, gathering people from different backgrounds to form teams, collaborate within a limited time frame, and focus on a specific problem or idea in healthcare to come up with innovative ideas and solutions.
  • COPD Primary Care Audit 2015-2017 report: Planning for every breathPlanning for every breath is the second of the Welsh COPD primary care audit reports and presents data relating to primary-care-delivered COPD care in Wales. The first Welsh primary care audit report was published in October 2016. A quality improvement (QI)-focused slide set, as well ...
  • Quality Improvement Toolkit For Early Diagnosis Of CancerThis toolkit is to help GPs and their practice teams to improve their early diagnosis of cancer principally by using the findings from the National Cancer Diagnosis Audit (NCDA). The NCDA is an audit of primary and secondary care data of patients diagnosed with cancer. It ...
  • Quality Improvement Project (QIP) Guidance for GP TraineesThe RCGP has produced some guidance for GP Trainees completing a Quality Improvement Project (QIP) as part of their training. Engagement with Quality Improvement activities is a mandatory part of the curriculum for GP trainees (‘Gold Guide’ Reference Guide for Postgraduate Specialty Training in the ...
  • Making the case for quality improvement: lessons for NHS boards and leadersThis briefing paper co-authored by The King's Fund and The Health Foundation outlines 10 lessons for NHS leaders that provide a starting point for leaders seeking to embed quality improvement in their work.
  • Atrial fibrillation toolkitThe Health Innovation Network have produced an AF toolkit as part of the Pan-London AF Programme. The three London AHSNs have worked collaboratively with the London Clinical Network to develop a pan-London AF programme, the objectives of which are: To increase the detection of people with ...
  • Quality Improvement toolkits – GP OneThe former Public Health Wales Primary Care Quality Team are now incorporated within the Primary and Community Care Development and Innovation Hub, and have developed a series of quality improvement toolkits to assist practices in collating and reviewing information. From information received, practices still find ...
  • Effective interface – RCGP ScotlandEffective Interface is an e-learning module to assist GPs and consultant colleagues to identify and provide solutions to problems that exist at the primary/secondary care interface.
  • Reporting and Learning from patient safety incidents in general practiceThe purpose of this guide is to: • maximise opportunities to learn from patient safety incidents in your practice, and to share learning via organisational or national reporting systems • outline a process for learning from patient safety incidents in your practice. Where appropriate, this guide will signpost existing well-written resources and does not seek to replicate their content.
  • QI Ready eLearning modulesThe RCGP has produced eLearning modules to compliment the QI Ready network and self-accreditation process. There are a suite of three modules that will assist you in better understanding quality improvement methodologies.
  • Quality Improvement HubThe Quality Improvement Hub website provides a range of resources to support organisations to improve the quality of healthcare in Scotland. The tools provided here can support you in your improvement work.
  • Quality improvement tools for different stages of QI projectsThe East London NHS Foundation Trust has developed and collated various tools and resources to be used at the different stages of a QI project.
  • Forcefield analysisForcefield analysis is an improvement tool that helps you to list, discuss and evaluate the various forces for and against a proposed change.
  • Webinar – How Quality Improvement can positively impact on patients with diabetesThis was the second of two QI in Diabetes Care webinars and was held on the 12th of January 2017, and followed ‘The experience of improving diabetes care’. This second webinar further explored issues surrounding improving care for patients with diabetes. The Webinar focused on patient ...
  • Webinar – The experience of improving diabetes careThis webinar explored issues surrounding improving the diabetes care using Quality Improvement methods and tools. The webinar gives an introduction to QI tools and methods, looks at their use in practice setting, and points to available resources.
  • Guide to managing ethical issues in quality improvement or clinical audit projectsThis guide is intended to help those responsible to review and develop arrangements for the effective ethics oversight of QI and clinical audit activities, as required.
  • National Diabetes Audit (NDA) 2015-16 publicationThe National Diabetes Audit has collected data from 2003-04 to the present day. The latest publication reports on care processes and treatment targets for the audit period 1 January 2015 to 31 March 2016.
  • RCGP Quick guide: Fishbone diagramThis RCGP Quick guide introduces Fishbone diagrams (also called cause and effect analysis) which are used to help to identify and display the root causes of a problem.
  • RCGP Quick guide: Clinical auditThis RCGP Quick guide provides the standard headings for a clinical audit report and gives tips on how to define and fulfil each section. It attempts to keep the process simple and will satisfy the requirements of General Medical Council (GMC) revalidation.
  • National Chronic Kidney Disease (CKD) Audit: National reportThis report details the findings of the CKD audit programme which compared GP practice performance against NICE quality standards.
  • RCGP Quick guide: Appreciative InquiryThis RCGP Quick guide introduces appreciative inquiry, a method that help groups of people working together to learn more from their success and to build on these to generate further improvements.
  • RCGP Quick guide: Externally Sourced DataThis RCGP Quick guide provides a comprehensive list of links to data sources that may be useful when undertaking quality improvement work.
  • RCGP Quick guide: Process and Value Stream MappingThis RCGP Quick guide introduces process and value stream mapping, techniques that creates a visual representation of all the steps in a process.
  • Presentation on safety netting for cancer diagnosis in primary careThis presentation introduces safety netting for cancer diagnosis in primary care and aims to support healthcare professionals to detect cancers earlier and minimise delayed diagnoses.
  • Safety netting for cancer diagnosis in primary careThis brief guide to safety netting for cancer diagnosis in primary care aims to support healthcare professionals to detect cancers earlier and minimise delayed diagnoses.
  • Resources for Cancer Significant Event Analysis training sessionsThis collection of resources are designed to support general practices to deliver effective Cancer Significant Event Analysis training sessions.
  • Significant Event Analysis GP Guide: Early Diagnosis of CancerThis guide will support GPs and colleagues in primary care teams to undertake an effective Cancer Significant Event Analysis (SEA), and identify any potential improvements in practice systems using documentation or proactive safety netting.
  • Example cancer singnificant event analyses with thematic analysisThese fictional example cancer singnificant event analyses (SEAs) demonstrate a varying range of quality. Each contains detailed notes showing both positive and negative examples of reflection, subsequent actions, and impacts following a cancer diagnosis.
  • Training resources for completing an effective cancer significant event analysisThis collection of resources have been developed with a 'train the trainer' approach as a guide to the process involved in completing an effective cancer significant event analysis (SEA).
  • Whitedboard video: Run chartsIn these videos Dr Robert Lloyd from the Institute for Healthcare Improvement introduces Run charts, a tool that allows practices to analyse data, with minimum use of statistical methods, and helps determine if an improvement has been made.
  • Whitedboard video: Pareto AnalysisIn this video Dr Robert Lloyd from the Institute for Healthcare Improvement introduces Pareto Analysis, a statistical technique in decision-making used for the selection of a limited number of tasks that produce significant overall effect.
  • RCGP Quick guide: Diagnostic SurveyThis RCGP Quick guide introduces diagnostic survey, a frequently used method used to identify the needs of the target group for any improvement work.
  • Diabetes Care quality improvement toolThe Diabetes Care quality improvement tool has been designed to help practices to audit their clinical data helping them to optimise the management and care of patients with diabetes and reduce their risk of developing associated complications.
  • Healthier Lives: DiabetesThe Healthier Lives: Diabetes website published by Public Health England pulls data about diabetes from a variety of sources. It then benchmarks GP practices within their CCG for performance related to both processes of care and the achievement of treatment targets.1 comment
  • Quality and Outcomes Framework (QOF) databaseThe Quality and Outcomes Framework (QOF) database is an online tool that pulls its data from published QOF performance data across the four nations of the UK. It allows you to compare your locality with others, as well as with national performance.
  • Model for improvement for diabetesDo you want to introduce a change to improve diabetes care? If so, the model for improvement for diabetes allows you to plan and test the change.
  • Healthcare Quality Improvement PartnershipThe Healthcare Quality Improvement Partnership is an independent organisation aims to improve health outcomes by enabling those who commission, deliver and receive healthcare to measure and improve our healthcare services. The HQIP website offers resources and support to help measure and improve healthcare services, especially in the areas of national clinical audit and quality improvement.
  • Clinical Practice Research Datalink PilotThis RCGP project aims to develop innovative uses of primary care data that will improve the quality of care delivered to patients. This will support and facilitate quality improvement via data reports tailored to individual practice populations.
  • Significant Event AuditSignificant Event Audit - also called Significant Event Review or Analysis - is an increasingly routine part of general practice. It is a technique to reflect on and learn from individual cases to improve quality of care overall.
  • QI Ready self-accreditationQI Ready is a self approval tool to assist you in better understanding quality improvement methodologies. It offers clear examples of QI in practice and will help you to improve your knowledge and skills in this field.
  • National Clinical Audit of STIs and HIV: Feasibility study reportThis one year feasibility study was funded by NHSE, commissioned by the Healthcare Quality Improvement Partnership, and ran from March 2015- March 2016
  • Data sources useful for QIA reference sheet detailing using data sources of comparative data.
  • Process mapping for diabetesThis process map offers a visual representation of all the steps in the process of caring for patients living with diabetes, from diagnosis of diabetes to annual review.
  • National chronic obstructive pulmonary disease (COPD) audit programme: Primary care report for England 2014–15This summary report has been published as part of the National COPD Audit Programme. It details national data relating to primary-care-delivered COPD care in England.
  • Executive summary for national COPD audit programme 2016The report, commissioned by HQIP as part of the National Clinical Audit Programme and carried out by the Royal College of Physicians, uses data provided by 280 practices across Wales, including 48,105 COPD patients, the report highlights areas for quality improvement and sets out a series of key priorities for both general practices and Health Boards.
  • National Diabetes Audit Quality Improvement Programme ReportThis report summarises the results and conclusions of a primary care diabetes quality improvement programme commissioned by NHS Digital and conducted by the Royal College of General Practitioners between June 2015 and September 2016.
  • Fishbone diagram for diabetes careIf you are trying to work out why patients don’t turn up for review or why the treatment target for blood pressure is not being met, then the Fishbone diagram for diabetes care can help you.
  • Best practice in clinical auditThe purpose of this guide is to set out updated criteria for best practice in local clinical audit. As well as the guide, check lists are available which can be used to assess healthcare organisations, clinical audit programmes and clinical audits against the criteria.
  • Strategic quality improvement: An action learning approachThis case study details the approach and philosophy behind work undertaken by the King’s Fund to work with Oxleas NHS Foundation Trust's Quality Board to facilitate an assessment of its existing approaches to quality improvement and to develop a strategy for future work.
  • Early Diagnosis of Cancer Significant Event Analysis ToolkitThis toolkit aims to support GPs, practice staff and commissioners in conducting high quality cancer Significant Event Analysis (SEA) with the aim of improving patient outcomes in the early diagnosis of cancer.
  • Healthcare science transforming patient care: Case studies from the National Healthcare Science Quality Improvement Champions GroupThis brochure contains a selection of case studies submitted by the membership of the QIC group to promote their contribution to transforming healthcare science services out in the community and ultimately improving patient care.
  • RCGP Quick guide: Diagnostic AnalysisThis RCGP Quick guide introduces diagnostic analysis, a method used to examine the group which will be affected by a change and the setting in which that change will occur before the start of implementation of the change.
  • RCGP Quick guide: Significant event analysisThis RCGP Quick guide introduces Significant Event Analysis a technique to reflect on and learn from individual cases to improve quality of care overall.
  • Clinical Audit Surgery PostersThe RCGP has produced a series of posters and animations in partnership with the London College of Communication to promote effective clinical audits in GP surgeries.
  • An introduction to statistics for local clinical audit and improvementThis guide sets out the basics of statistical data analysis and presentation for those involved in local clinical audit and improvement projects.
  • Improving the quality of end of life experiencesThis submission demonstrates involving the bereaved in quality improvement, the value of relatives and carers sharing experiences, and quality improvement through difficult to reach groups.
  • National Cancer Diagnosis AuditThe National Cancer Diagnosis Audit (NCDA) aims to help review practice processes and improve cancer outcomes. The audit will look at cancer diagnosis and implementation of clinical standards to inform delivery of best care for cancer patients.
  • What is clinical audit? And other frequently asked questionsA simple guide covering common FAQs on clinical audit.
  • Haxby Group Practice: adding a pharmacist to the teamIn this article published in Guidelines in Practice, Dr Michael Holmes and Sarah Woffinden respond to questions on the addition of a pharmacist to the practice team, and discuss the positive impact it has had on both patients and staff alike.
  • Co-produced support for carers of those with dementiaA 2015 case study from NHS Luton Clinical Commissioning Group, who worked with carers of those living with dementia to understand and address the issues they faced, after it was identified many were reaching crisis point.
  • A guide to good quality coding and safety netting for cancer diagnosisThis guide to quality coding and safety netting for cancer diagnosis aims to enhance patient safety by having the most up-to-date and connected information about your patient at your fingertips, regardless of how long you have known the patient.
  • Whitedboard video: Force Field AnalysisIn this video Dr Robert Lloyd from the Institute for Healthcare Improvement introduces Force Field Analysis, a tool that helps you to list, discuss and evaluate the various forces for and against a proposed change.
  • Whitedboard video: Cause and effect diagramsIn this video Dr Robert Lloyd from the Institute for Healthcare Improvement introduces cause and effect diagrams, also known as fishbone diagrams, which are used to help to identify and display the root causes of a problem.
  • Tower Hamlets: Managed practice networks to improve rates of cardiovascular diseaseFrom 2009 NHS Tower Hamlets spent an additional £2 million per year to improve the quality of primary care. This included the implementation of a system of managed clinical networks across all primary care teams in 2009.
  • National Diabetes AuditThe National Diabetes Audit (NDA) is a major national clinical audit, which measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards, in England and Wales.
  • Improving the quality of cancer care in primary careThis toolkit developed by Macmillan Cancer Support aims to support the primary care professionals to develop initiatives and programmes which have a positive impact on the care of people daiagnosed with cancer, their families and carers.
  • Enhanced Significant Event AnalysisEnhanced Significant Event Analysis is an NHS Education for Scotland innovation which aims to guide health care teams to apply human factors thinking when performing a significant event analysis, particularly where the event has had an emotional impact on staff involved.
  • Whitedboard video: Control chartsIn these videos Dr Robert Lloyd from the Institute for Healthcare Improvement introduces control charts, also known as Shewhart charts, which are used to display the measure of interest over time with the mean plotted as an X bar.
  • Cancer Significant Event Audit Peer Review pilotThis joint initiative undertaken by the RCGP, the National Cancer Action Team and Macmillan Cancer Support, offered anonymised external peer assessment of Significant Event Audits of cancer diagnosis.
  • Whitedboard video: FlowchartsIn these videos Dr Robert Lloyd from the Institute for Healthcare Improvement introduces flowcharts, a tool used to depict the sequence of movements or actions of people or things involved in a complex system or activity.
  • Quality improvement made simple: What everyone should know about healthcare quality improvementThis guide, from The Health Foundation, focuses in particular at what are known as organisational or industrial approaches to quality improvement.
  • Whitedboard video: PDSA cyclesIn these videos Dr Robert Lloyd from the Institute for Healthcare Improvement introduces the Plan-Do-Study-Act (PDSA) approach, a technique that allows change to be introduced in a considered way but on a small and manageable scale, measuring the ‘before’ and ‘after’ effects of each change, and provides evidence to assist in maintaining the changes that work.
  • Whitedboard video: Driver diagramsIn this video Dr Robert Lloyd from the Institute for Healthcare Improvement introduces driver diagrams, which are used to helps you to translate a high level improvement goal into a logical set of underpinning causes or drivers.
  • Significant Event Audit: guidance for primary care teamsThis guidance published by NHS Education for Scotland aims to support primary care teams in conducting effective significant event audits with the aim of improving care for all patients.
  • Safety netting to improve early cancer diagnosis in primary careThese consensus guidelines identifies and prioritises the different components of safety netting in relation to cancer diagnosis in primary care.
  • Improving access, responding to patients: A ‘how-to’ guide for GP practicesThis guide is a celebration of some of this good practice, sharing the successes and signposting real examples of things that have proven to work, things that make a real difference for patients and the working lives of our staff.
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