Rosaline Eve, Director, Centre for Innovation in Primary Care

The Centre for Innovation in Primary Care (CIPC) was formally established as a charity in 1998. It grew out of a series of NHS-funded, long-term primary healthcare development projects to help organisations and professionals flourish and give of their best.

Governed by a Board of Trustees, the CIPC is outside the statutory sector, free from commercial interests and dedicated to working collaboratively across all primary care organisations. Current sources of funding include primary care groups and trusts (PCG/Ts), Sheffield Health, the NHS Executive Trent and the DoH.

Objectives of the CIPC

The CIPC has two aims:

  • To help busy clinicians and managers in primary care develop innovative solutions to the problems they face
  • To increase the innovative capacity of primary care, and thereby improve services.

The CIPC takes the approach that any innovation is most likely to improve care if it both draws on the learning and experience of others (including those outside the health and social care disciplines) and helps to solve local problems.

The key to bringing about successful change is to work with professionals' motivations. If people cannot see a good reason to change they are unlikely to do it well.

The vast majority of health and social care professionals want to give the best possible service. If they are resistant to change they probably have good reasons for their resistance. The CIPC aims to work alongside professionals throughout the health and social care community to help them overcome any problems.

Four primary healthcare development projects that grew into the CIPC are described in Figure 1 (below).

Figure 1: The primary healthcare development projects that grew into the CIPC
  • The facts project: a framework for implementing evidence-based clinical change across large numbers of general practices. Using techniques such as marketing and selling, translation between professional and organisational cultures, building coalitions of interest and systematic information support systems, facts successfully promoted the adoption of clinical change.
  • The Practice Data Comparison project: this gave practices the opportunity to compare and discuss standardised data relating to general practice utilisation rates, finances, morbidity rates and clinical variation – with each other, with national standards and over time.
  • The Evaluating Quality in Practice (EQUIP) project: systematic surveys to find out 'what is' across primary care – replacing anecdote by evidence.
  • Towards Coordinated Practice project: an exploration of how general practices can best collaborate with each other and other agencies to improve patient care.

CIPC project teams are drawn from many different backgrounds, including: general practice; management (both public and private sector); clinical (GP, public health and nursing); sociology; psychology; qualitative and quantitative research; and education and training.

Activities

General practice has always been a key building block of the primary healthcare system in the UK. Working with large groups of general practices has therefore been central to the work of the CIPC. Building on this expertise, current CIPC development programmes assist the development of PCTs. Examples of current areas of work include:

Demand management and capacity building

The drive to reduce waiting lists and demand for hospital services by building primary care capacity has prompted a wide range of experiments around the country.

In the past, this sort of experimentation has been left to the enthusiasm and energy of individual GPs. PCTs now have the opportunity to take a more strategic approach, and many clinicians and managers are working hard to bring about similar changes. Yet finding out who has invented the wheel, where, and what their learning was is far from easy.

Where the information does exist, it is usually scattered between journals, government reports, an ever-expanding number of websites, and unpublished strategy documents. Even then, the innovation may not have been evaluated, evidence may be contradictory and no systematic review of it may yet exist.

Economic evaluations of the costs and benefits of service change are rare. Commissioned by Sheffield Health and Sheffield PCGs, the CIPC has recently carried out a 'horizon scanning' exercise to provide an overview of experiments undertaken around the country. (An analysis, overview and signposts to further information have recently been published by CIPC.)

Improving patient access to general practice

CIPC has extensive experience of helping general practices learn from each other how to organise appointment systems so that they best serve the needs and expectations of local people. We are currently working with a group of PCG/Ts to help them meet the targets set in The NHS Plan.

Heart failure programme

This programme follows on from the facts project clinical change programmes, and is the fourth in a series to help primary care professionals on the ground implement the National Service Framework (NSF) for Coronary Heart Disease (CHD).

The Health Visitor and School Nurse Innovators' Network

Over the past decade, health visitors and school nurses have spent much of their time isolated from the rest of the NHS. Many felt that they were fighting for their own professional survival, and had pretty much been left to their own devices. Perversely, this systemic 'neglect' led to a wide array of profession-led experiments to work out ways of improving the service provided.

More recently, a number of government policy developments have recognised their potential. Using an actively facilitated, website-based directory of innovation and an e-discussion group, the DoH has funded the innovators' network to help support development, selection and adoption of new ideas and innovative solutions in this field.

Shadowing

For the past 10 years, the CIPC has run a series of shadowing programmes to help professionals across the health and social care community gain a better understanding of each other's worlds. The most recent programme focused on professionals involved in providing services for older people.

Products/resources

The CIPC works with primary health and social care organisations to:

  • Promote collaboration
  • Implement systematic, evidence-based change
  • Promote learning between professional groups and organisations
  • Support primary-care led commissioning.

Products include:

  • Surveys to replace anecdote by evidence, giving coherent voice to practice and perceptions across primary health and social care: past surveys have looked at diverse issues, ranging from access to acute hospital beds, the appropriateness of statin prescribing and the roles and responsibilities of practice nurses through to patient perceptions of access to primary healthcare.
  • Programmes to facilitate learning across organisations: action learning sets, shadowing programmes and the collection and comparison of standardised data sets are all techniques that the CIPC uses to help professionals learn from each other and to undertake critical review of their own practice.
  • Evaluation – the key to successful dissemination. The CIPC designs and carries out qualitative and quantitative evaluations of innovation in primary healthcare. Evaluation can establish whether or not the change has been successful, and what change was achieved. It can also help to develop our collective understanding of what worked, how it worked, what didn't work and why. Perhaps even more crucially, it can give change agents – the people who are trying to bring about the change – the opportunity to develop their skills, and thereby the NHS's capacity, to manage successfully the rising tide of new demands that threaten to engulf us.

    CIPC evaluations endeavour to maximise learning while making sure the tail doesn't wag the dog and the evaluation methods do not inhibit the innovation itself.

  • Programmes to implement systematic, evidence-based clinical change, based on the learning from the facts project: the CIPC works alongside health professionals to help them bring about clinical change that is in line with best evidence and National Service Frameworks.

For copies of CIPC reports, tools to help bring about change in primary care and further information about the CIPC development programmes, visit the website at www.innovate.org.uk (see Figure 2, below).

Figure 2: Page from the Centre for Innovation in Primary Care website
Web page
The Centre for Innovation in Primary Care
Set up 1988
Objectives To help busy clinicians and managers in primary care develop innovative solutions to the problems they face, and to increase the innovatory capacity of primary care
Funding Independent, not-for-profit charity, funded by the NHS. Current funders include the Department of Health, Sheffield Health, primary care groups and NHSE Trent
Key personnel Director: Rosalind Eve
  Development Facilitator: Wendy Sunney
  Public Health Advisor: Dr James Munro
  Nursing Advisor: Kate Gerrish
  Administrator: Julie Bentley
  GP Advisor: Dr Helen Metcalf
  Health Information Analyst: John Waller
  e-Discussion Group Facilitators: Annette Hogarth and Rosie Kightley
  Training and Education Consultant: Penny Mares
Contact details: Address: The Centre for Innovation in Primary Care, 1st Floor, Walsh Court, 10 Bells Square, Sheffield S1 2FY
  Tel: 0114 220 2000
  Fax: 0114 220 2001
  Email: cipc@innovate.org.uk
  Website: http://www.innovate.org.uk

Guidelines in Practice, June 2001, Volume 4(6)
© 2001 MGP Ltd
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