What do patients accessing a specialist homeless GP service in Glasgow ALWAYS want to happen when they attend?

Problem

The use of quality improvement (QI) initiatives to drive improvement in primary care is a national priority. Most QI is directed by clinicians, based on their priorities or local, and national, guidance. The Always event (AE) concept takes a patient-centred approach to QI where patients identify what is so important to them that it should always happen. The AE concept has been described as having an ‘open architecture’. This allows providers to identify and contextualise their own patients’ priorities to direct improvement efforts. The mix of people who experience homelessness are a vulnerable, under-represented group, who struggle to access mainstream primary care. This has led to the development of specialist primary care provision across several cities in the UK. Increasing client participation in service design is recognised as a priority for all homeless services as this leads to improved engagement.The AE approach has been adapted for Scottish primary care but has never been tested in a healthcare setting for the homeless population. We aim to test the applicability of the AE approach to directing QI in a GP practice serving homeless patients in Glasgow.

Approach

Consecutive attenders at a GP drop-in surgery at a specialist primary care service for homeless people in Glasgow are invited to take part. A healthcare assistant will interview patients and ask, “What is so important to you that it should ALWAYS happen when you visit this GP surgery”. Three responses will be sought from each patient. Once data saturation is achieved, responses will be transcribed, coded and themed by the authors. Candidate AEs will be generated and assessed against the following criteria to generate always events:• Any healthcare interaction, process or outcome that is judged by patients, carers or relatives to be a highly important determinant of care quality and experience • Feasible as part of routine health care delivery• Unambiguous and specific to enable reliable measurement• Consistently deliverable to applicable patient groups by all relevant health care organisations, teams and individualsGenerated AEs will direct a QI project

Findings

By July we expect to have generated specific AEs for our population. We will use appropriate QI methods to measure the success of improvement interventions.

Consequences

Patient participation in the development and improvement of health and care services has been difficult to implement in primary care in a meaningful way. The homeless patient group has historically had little input to service development. This project will evaluate an approach that uses patient-generated AEs to drive improvement in their primary care services. If proven to be successful, the AE concept may inform provision of person-centred care for wider vulnerable groups trying to access health and care services