Usher Institute, University of Edinburgh, Edinburgh.
Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee.
Br J Gen Pract. 2021 Aug 26;71(710):e719-e727. doi: 10.3399/BJGP.2020.1101. Print 2021 Sep.
Scotland abolished the Quality and Outcomes Framework (QOF) in April 2016, before implementing a new Scottish GP contract in April 2018. Since 2016, groups of practices (GP clusters) have been incentivised to meet regularly to plan and organise quality improvement (QI) as part of this new direction in primary care policy.
To understand the organisation and perceived impact of GP clusters, including how they use quantitative data for improvement.
Thematic analysis of semi-structured interviews with key stakeholders ( = 17) and observations of GP cluster meetings ( = 6) in two clusters.
This analytical strategy was combined with a purposive (variation) sampling approach to the sources of data, to try to identify commonalities across diverse stakeholder experiences of working in or on the idea of GP clusters. Variation was sought particularly in terms of stakeholders' level of involvement in improvement initiatives, and in their disciplinary affiliations.
There was uncertainty as to whether GP clusters should focus on activities generated internally or externally by the wider healthcare system (for example, from Scottish Health Boards), although the two observed clusters generally generated their own ideas and issues. Clusters operated with variable administrative/managerial and data support, and variable baseline leadership experience and QI skills. Qualitative approaches formed the focus of collaborative learning in cluster meetings, through sharing and discussion of member practices' own understandings and experiences. Less evidence was observed of data analytics being championed in these meetings, partly because of barriers to accessing the analytics data and existing data quality.
Cluster development would benefit from more consistent training and support for cluster leads in small-group facilitation, leadership, and QI expertise, and data analytics access and capacity. While GP clusters are up and running, their impact is likely to be limited without further investment in developing capacity in these areas.
苏格兰于 2016 年 4 月废除了质量和成果框架（QOF），然后于 2018 年 4 月实施了新的苏格兰全科医生合同。自 2016 年以来，作为这一初级保健政策新方向的一部分，鼓励一群实践（GP 集群）定期开会，规划和组织质量改进（QI）。
了解全科医生集群的组织和感知影响，包括它们如何使用定量数据进行改进。
对两个集群中的关键利益相关者（= 17 人）进行半结构化访谈和对全科医生集群会议（= 6 次）进行观察的主题分析。
该分析策略与数据来源的针对性（变化）抽样方法相结合，试图在不同利益相关者在参与或参与全科医生集群理念方面的经验中识别出共同之处。特别寻求变化的是利益相关者在改进计划中的参与程度以及他们的学科背景。
关于全科医生集群是否应专注于由更广泛的医疗保健系统（例如苏格兰卫生委员会）内部或外部产生的活动存在不确定性，尽管观察到的两个集群通常会产生自己的想法和问题。集群的行政/管理和数据支持各不相同，基线领导经验和 QI 技能也各不相同。在集群会议中，通过共享和讨论成员实践自己的理解和经验，定性方法成为协作学习的重点。在这些会议中，观察到数据分析的支持较少，部分原因是获取分析数据和现有数据质量的障碍。
集群发展将受益于对小组成员促进、领导和 QI 专业知识以及数据分析访问和能力方面的更一致的培训和支持。虽然全科医生集群已经启动并运行，但如果不在这些领域进一步投资以发展能力，其影响可能有限。
