June 2021 Update

EQUIP still offers standard QI coaching (see our mission statement below) but due to Covid we are being asked more and more to help practices deliver a Digital Offer. This can be accessed within the Digital 2020 tab. We have therefore revamped the website to give some really practical help on:

Please click on any of the above digital offers for more information on how you can implement these within your practice.

We also know that staff are under a lot of pressure. We have therefore updated our staff Wellbeing section to explain what support is currently on offer.  Please check out the Wellbeing tab. Additionally under the Wellbeing tab, we have an exciting new section called Thinking Space, which helps individuals, teams and organisations better understand themselves. We really hope this is useful.

Please have a look at the new material and ask your QI coach or email the EQUIP team here for further help.

Our Latest Newsletter (22/11/2021)

In this ‘new-normal’ world, the EQUIP Team, EQUIP coaches and Thinking Space team want to wish you old-fashioned pleasures, happy memories and all the joys over those holidays.

Our gift for you is this useful tool, often overused and difficult to interpret: the funnel plot.

Enjoy the readings and for any questions please get in touch with Adele (adele.testa1@nhs.net)


What is a funnel plot?

These are graphs that visualise variation within a system and identifies statistical outliers within it. 

The y-axis represents the activity measure (either a proportion or rate per 1000 patients) while the x-axis represents the denominator.

These are represented as follows:

·         The x-axis can represent the potential maximum frequency of the activity being measured when the funnel plot is measuring proportion of activity 

·           e.g. the x-axis showing the number of booked appointments while the y-axis displays DNA percentage rate

·         The x-axis can also represent the population when the funnel plot is measuring rate per 1000

·           e.g.  The x-axis showing the practice list size while the y-axis  displays referral rate per 1000

·         Dots on the funnel plot represent GP practices. 

·         The middle straight line presents the average for all practices 

·         Lines either side of the mean represent the confidence limits (as seen in figure  1)

Why should I use a funnel plot?

Funnel plots allow the user to interpret the variation within a system. 

If you wanted to compare vaccination rates between a group of practices, you may be tempted to simply order the practice by their vaccination rates from highest to lowest and look to focus on improving the practices on the lower end.

While this is feasible, the problem with this method is that It does not account for:

·The account for the number of patients legible for vaccinations in that practice

·The differences in practices vaccination rates being due to the normal variation that exists within systems

How to interpret a funnel plot?

1)     Identify your practice on the funnel plot.

2)    Does your practice sit outside of the +/-99.9% control limit?

a. If your practice does sit outside of this, then the practice is showing special cause variation and is a statistical outlier when compared to the other practices.

  i. Special cause variation: variation that is caused by special circumstances or events that are out of the ordinary. 

b. If your practice sits within the +/- 99.9% control limit, them your practice is showing common cause variation and is not an outlier.

  i. Common cause variation: variation caused by ‘normal’ events 

3)    The smaller the x-axis value, the wider the confidence limit because our confidence in the rate of activity displayed being an accurate reflection on how well the practice is doing decreases when we have a smaller sample 

EQUIP – The WHY we should embrace QI

The EQUIP Mission Statement

Making Tower Hamlets the best place to work, and the best place to receive care.

The world of General Practice is currently under significant pressure. Across the board budgets are being cut, and resources constrained. ‘On top of this, practices face a rapidly growing population, thus in turn increasing demand for GP services. The growing population has different health needs from those of the past, forcing practices to re-evaluate the efficacy of their business models and clinical processes. As a result of these challenges, practice staff are under unprecedented levels of stress, leading to recruitment and retention challenges.

Our response to these conditions is to roll up our sleeves, and address these issues head on. The EQUIP (Enabling Quality Improvement in Practice) programme is designed to do just that, by providing practice staff with the tools to create meaningful and lasting change. This is done by allowing practices to work on what matters most to them through a tried and tested Quality Improvement methodology. By doing this, we hope to improve the lives of staff and develop a culture within practices that values bottom-up change and continuous improvement. We also hope that we will make General Practice resilient and effectively able to manage current challenges and variation, and lead change so it can deliver even better care to patients in the future’.