SPQS Evaluation October 2015
The academic team evaluating SPQS have provided their final report, which will be available at www.swahsn.com
Here are the headlines:
- Practices are making significant progress towards more person-centred care
- There has been an improvement in morale and practitioner experience
- There is no evidence that the quality of care has deteriorated
Read on for more detail from the academics report:
Quality, QOF and SPQS:
- QOF is challenged by evolving notions of quality that go beyond procedural baselines and incorporate holism, person centred care and coordination.
- Although all QOF indicators have dropped, there is no evidence of a reduction in the quality of care. For example, data for cholesterol values and HbA1c reveal essentially no difference in outcomes for SPQS and QOF practices, or non-elective admissions for LTCs.
Person Centred Care:
- There was a genuine passion and commitment to improving person-centred care among all those we interviewed or came in contact with through the evaluation.
- There were also clear articulations of the perceived opportunities that freedom from QOF and trialling new ways of working could bring, for example in sustainable collaborative arrangements in federations.
- In some practices the freedom from QOF had widespread benefits for the whole workforce (e.g. reception staff were more engaged with more fulfilling roles).
- Practices also experienced a number of barriers to this process e.g. a lack of organisational agreements and fragmented IT systems.
- Organisational change was demonstrated through: reallocation of resources to support health care assistant/nurses/others to take on more of the assessments and reviews traditionally undertaken by GPs; creation of new staffing appointments and retraining of current staff; initiation of direct access to specialist nurses; increased appointment times and better coordinated appointments to meet patient needs.
More time, improved morale and increased satisfaction
- Increased time was the most substantial impact of the shift to SPQS and this positively affected the delivery of person-centred care, which in turn fostered more innovation, improved staff morale and work satisfaction and importantly provided a renewed sense of pride in work.
- Within this context practitioners talked about seeing the whole person, working with them to understand what is important to them and creating longer appointments to enable this.
- Practices were using multidisciplinary team working to plan the most suitable care for individuals.
- There was a perception that activities that support and foster coordination across teams should be given a priority focus (i.e. engaging social care and mental health in MDTs etc).
- Practitioners reported that caring for people in a holistic way and supporting them to self manage has positive effects on the practitioner and patient relationship.
- Individuals across both SPQS and QOF practices reported positive experiences with their care in respect of relational continuity.
- There was emerging evidence that the number of contacts patients have in order to meet their needs is being reduced in some of the SPQS practices that we interviewed.
- We also found encouraging evidence from the SPQS practices interviewed that individuals and clinicians decide priorities together through shared decision making.
- Small incremental gains from suspending QOF were being used by SPQS practices to concentrate on the work that provides most value.
- The main barrier to effective coordination was perceived to relate to communication issues hampered by lack of effective IT systems.
- Barriers were reported in relation to achieving locally shared agreements and plans, but practices were striving to work together to pilot new ways of working irrespective of this difficulty (e.g. using networks to engage other agencies with MDT working).
The academics concluded that an extension of the pilot would be beneficial. The CCG and NHS England have agreed that the pilot will be further extended for the 2016/17 contract year in order to allow further evaluation.