workshops: findings

The outputs from the two phase 1 workshops were initially collected on flip charts, collated and

transcribed into summary statements. A total of 484 summary statements from the two workshops were transcribed; these were then coded thematically.

Initially, 19 themes were recorded. These are shown inTable 4.

These themes, and the statements that led to them, were then discussed by several members of the research team. Following this discussion, the themes were arranged into nine objectives that were agreed to cover all of the themes with appropriate separation, keeping all areas included, but limiting overlap to a minimum (a certain level of overlap was considered inevitable).

The nine objectives formed are shown inTable 5.

These were the objectives taken forward into the phase 2 workshops. However, it became clear during the phase 2 workshops (backed up by the Study Steering Committee and initial consensus exercise meetings) that the first of these objectives, better clinical care, was too broad and complex to be represented by a small number of indicators (the expectation had been up to five or six indicators per objective). It was likely that around 20 or more indicators would be necessary to capture even the most important aspects of this objective. After careful consideration, therefore, it was decided that this should be split into three different areas, representing the areas suggested by the phase 2/3 workshops: (1) general health and preventative medicine, (2) management of long-term conditions and (3) clinical management.

Perhaps unsurprisingly,‘better clinical care’, as an objective, was considered by almost all participants as one of the top objectives of the general practice. Therefore, this additional weighting by tripling the number of indicators was viewed as appropriate by participants in the phase 2/3 workshops.

TABLE 4 Themes from phase 1 workshops

Theme Examples/further detail

Access to care Timely and appropriate access; right person/practitioner; equitable, based on need Managing demand Methods to use resources and manage patient expectations

Appointments Longer or more flexible appointments in accordance with need, better use of technology, multidisciplinary staff, reduced duplication

Practice staff Good team meetings, staff morale, retention, appropriate training

Reception Use of triage; good training, sensitive to confidentiality; pleasant, customer-service focused Patients_’experience Confidence, expectation, satisfaction

Signposting/referrals Patients seen by right person at right time for their need/condition; appropriate referrals to other services

Continuity of care Ability for patients to see same practitioner Environment Quality of premises (e.g. poor buildings)

PPGs Effective use of groups; communication with groups; support for groups; representation of population engagement

Communication and engagement

Increase patient confidence and expectation; appropriate use of technology to engage with community; planning effective services and sharing learning; using a range of methods. It was clear that many public representatives felt that they were not being communicated with effectively

Transparency and accountability

Good, clear, appropriate information (about what is on offer, missed appointments, what to expect, specific conditions)

Shared teamworking and reflective practice

Effective meetings; integration and connectivity; learning from others Health outcomes All, but especially with key groups

Technology Optimising IT systems; using a range of methods for communication; use for making appointments; test results

Personalised, holistic care A range of services offered in practice Social prescribing/

integration

Care integrated with other local organisations Choice Choice of practice; choice of type of care

Type of care Decisions between continuity of care and care tailored to specific need

PPG, patient participation group.

STAGE 1: DEVELOPING THE MEASURE

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However, this also left a total of 11 objectives, clearly more than the six to eight considered ideal by ProMES experts. The focus on 11 different areas was also likely to be a source of confusion for practices. Therefore, it was decided to create a superordinate level of objectives, termed‘performance areas’. Discussion between members of the research team, and the Study Steering Committee, resulted in four performance areas: (1)clinical care, (2)external focus, (3)patient focusand (4)practice management. Each objective would then contribute to one of these performance areas. The alignment between performance areas and objectives is shown inTable 6andFigure 6.

TABLE 6 Performance areas and objectives

Performance area Objective

Clinical care General health and preventative medicine Management of long-term conditions Clinical management

External focus Good partnership working Engagement with public

Patient focus High levels of patient satisfaction with services Ease of access and ability to book appointments Practice management Effective use of IT systems

Good physical environment

Motivated and effective practice team Good overall practice management

TABLE 5 Objectives derived from phase 1 workshops

Objective Description/examples

Better clinical care Effective consultations, health outcomes for key groups, appropriate prescribing, safety, public health indicators

Effective use of IT systems Quality of coding, audits, call-back systems, appropriate communication with patients

Good partnership working Liaisons with other key constituents (local authority, voluntary services, other NHS organisations), co-ordination with and learning from other practices

High levels of patient satisfaction with services

Quality of consultation, availability of information, range of services offered

Ease of access and ability to book appointments

Waiting times, equity, flexibility, effective triage systems, opening hours, continuity of care

Engagement with public Effective use of PPG, good sharing of information, communication with wider community, informative website

Good physical environment Quality of premises, confidentiality of information sharing with receptionists, etc., disabled access

Motivated and effective practice team Team member satisfaction, well-being, retention, interprofessional co-ordination, appropriate roles, training

Good practice management Leadership, financial sustainability, workforce planning, meeting regulatory requirements

Although the decision to adopt these performance areas was not taken until well into the phase 2/3 workshops, it is reported here so that the reporting of the findings from phases 2 and 3 (in the following section) is made clearer for the reader.