Quality Improvement

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What is Quality Improvement (QI)?  

Quality Improvement (QI) in Derbyshire primary care offers a structured approach to evaluating and enhancing our practices in general practice. It encourages us to examine both large and small aspects of our work through a fresh perspective to identify areas for improvement. 

It involves: 

  • Values: Self-reflection, shared learning, partnership, leadership, and understanding of context. 
  • Methods: Measurement, understanding variation, and cyclical improvement processes like the PDSA cycle. 

The PDSA (Plan-Do-Study-Act) cycle

PDSA QI Graphic .png (277 KB)

 

Impact of QI Fellowships on Practices, Staff, and Patients in Derbyshire 

In Derbyshire, we’ve seen first-hand how Quality Improvement (QI) work is making a real difference across practices, for staff and for patients. From improving patient care and boosting staff wellbeing, to reducing GP turnover and building leadership and confidence, the impact is both wide-reaching and deeply meaningful. 

- The data and insights shared here are drawn from a recent impact study completed in June 2025 as part of the GPTF Fellowship Programme evaluation in Derbyshire. 

GP Turnover Dropped by Over 50% 

GP leaving rates fell from 12.5% in 2023 to just 5.8% in 2025, showing the Fellowship programme’s role in improving retention. 

2 in 3 Fellows Saw Direct Patient Care   

Improvements Projects led to better access, reduced hospital admissions, and tailored care—especially in areas like respiratory medicine and care homes. 

67% More Likely to Pursue Leadership Roles    

The programme boosted confidence and ambition, encouraging more professionals to step into system-level and leadership positions 

Every Fellow Gained New Skills   

All respondents reported improved understanding of the NHS, with two-thirds gaining project management and leadership skills. 

Getting Started with Your QI Project 

If you're thinking about starting your own Quality Improvement (QI) project, our QI Portal is your one-stop resource for everything you need to succeed. From practical tools and templates to expert guidance and inspiring case studies. 

 Whether you're new to QI or looking to build on previous work, the portal offers: 

Getting Started with QI Tools 

Learn how to embed QI methods into everyday practice with simple, effective tools. 

 Measuring What Matters

Discover how to collect and interpret data to track your progress and demonstrate impact.

Engaging Stakeholders

Find out how to identify and involve the right people to support your project’s success. 

Tackling Bias and Inequality

Explore how to recognise and address bias in healthcare improvement work.

Using Observation in PDSA Cycles

Learn how observational methods can strengthen your Plan-Do-Study-Act cycles.

Join the QI Portal 

Perth House and Primary Healthcare Derby Complex Care Interface Pilot 

The Perth House and Primary Healthcare Derby (PHD) Complex Care Interface Pilot was established to strengthen support for people with complex health, wellbeing and social needs as they transition from rehabilitation back into the community. The pilot formed part of a wider test-and-learn programme exploring how services, communities and individuals can work together through neighbourhood-based approaches to improve outcomes and independence.  

The pilot focused on creating a more coordinated approach between Perth House and the PHD Complex Care Team, helping people access the right support earlier, reducing fragmentation between services and improving continuity of care during a vulnerable stage of their recovery journey.  

What the Pilot Achieved 

Over the course of the pilot, significant progress was made in building relationships, developing referral processes and strengthening multidisciplinary working across organisations. A dedicated referral pathway, supported by a Standard Operating Procedure and patient information resources, was successfully established and refined during implementation.  

The PHD Complex Care Coordinator attended weekly Perth House multidisciplinary team meetings, creating opportunities for early identification of patients who would benefit from additional support and helping to embed collaborative working practices.  

Strong partnerships were developed between rehabilitation, primary care, social care, community services and voluntary sector organisations, improving communication and creating more joined-up support for patients returning home.  

Referral Activity and Patient Support 

The pilot received 21 referrals, with demand increasing as awareness of the pathway grew. Nearly half of those referred (47.6%) received support and were successfully discharged from the service within four weeks, demonstrating that timely, coordinated interventions can often prevent issues from escalating.  

Only a small number of patients required escalation to the full Complex Care Team, showing that early intervention and coordination can effectively address many practical, health and wellbeing challenges before more intensive support is needed.  

The variety of onward referrals highlighted the complexity of need within this population. Support included: 

  • Home safety interventions 
  • Benefits and financial wellbeing advice 
  • Housing support 
  • Pharmacy services 
  • Social care referrals 
  • Community wellbeing programmes 
  • Safeguarding support 

These interventions demonstrate that successful discharge is influenced not only by clinical care, but also by wider social determinants of health and wellbeing 

James' Story 

Mr M's Story

Why This Matters 

A recurring theme throughout the pilot was the vulnerability of the transition between rehabilitation services and returning home. While many patients no longer require specialist rehabilitation, they often need practical support to navigate daily living, maintain independence and remain connected to appropriate services.  

The pilot demonstrated that relatively small interventions can have a significant impact. Support with activities such as accessing a mobile phone, arranging internet access, understanding medication processes or connecting with community services can make the difference between thriving at home and experiencing avoidable deterioration or readmission.  

The work reinforced the importance of understanding what matters most to individuals and organising support around their goals, circumstances and community connections. 

Key Learning 

Relationships Drive Integration 

The strongest enabler of success was not the referral process itself, but the relationships developed between professionals and organisations. Trust, visibility, shared understanding and regular communication were essential in embedding the pathway and supporting coordinated care.  

Multidisciplinary Working Adds Value 

The pilot demonstrated how multidisciplinary working can reduce fragmentation, improve communication and enable more holistic assessment and support planning. 

Neighbourhood Working Requires Infrastructure 

Integrated neighbourhood care depends on more than good intentions. It requires dedicated coordination, strong local networks and the ability to connect services around the individual rather than expecting people to navigate complex systems themselves. 

Success Cannot Be Measured Through Activity Alone 

Many of the pilot's achievements were relational rather than transactional. Improved partnerships, stronger communication pathways, increased awareness of available services and greater confidence in collaborative working all contributed to success but are not easily captured through traditional activity metrics. 

Challenges and Risks 

The pilot also highlighted several challenges that will need to be addressed if this approach is to be sustained and scaled: 

  • Reliance on key individuals creates vulnerability when staff are absent or roles change.  
  • Funding for key elements of support, including the physical activity programme, remains short term.   
  • Variations in local service models make pathways more difficult to implement consistently across Derbyshire.  
  • Current reporting frameworks do not fully capture the value of relationship building, partnership development and neighbourhood working.  

Conclusion  

The pilot has demonstrated the potential value of a coordinated, neighbourhood-based approach for people transitioning from rehabilitation to home. While still at an early stage, it provides a strong foundation for future service development.   

The key lesson is clear: successful neighbourhood health is built on trusted relationships, effective coordination and services working together around the person. The challenge now is to ensure the infrastructure, workforce and investment are in place to make this approach sustainable and consistently available across Derbyshire.