In the ever-evolving landscape of primary healthcare, it’s crucial to keep abreast of the changes that directly impact the way we work. One such change that requires our attention is the introduction of the Quality Outcomes Framework (QOF) Quality Improvement (QI) Staff and Wellbeing Module. This new module, designed to reduce the risk of burnout among GP and practice staff while fostering resilience and wellbeing, forms part of the QOF activity for practices from April onwards​​.  You can read the guidance in its entirety here.

What is the Quality and Outcomes Framework (QOF)?

The Quality and Outcomes Framework (QOF), an essential part of the NHS contract with general practices in the UK, encourages the delivery of high-quality care. It’s a system for the performance management and payment of general practitioners (GPs) in the National Health Service (NHS) in England, Scotland, Wales, and Northern Ireland. With the advent of the new QOF framework, the focus has been shifted more towards achieving better health outcomes for patients. The QOF awards practices for the provision of ‘quality care’ and helps standardise improvement in the delivery of primary medical services. To understand more about the QOF and how it impacts the NHS, visit the NHS’s Quality and Outcomes Framework guidance for 2023/24.

What has changed in the new QOF framework?

In the new QOF framework, there is a noteworthy emphasis on reducing the risk of GP and practice staff burnout. The new guidelines require practices to review all work-related factors affecting wellbeing, particularly focusing on workforce planning. The measures include access to flexible working, understanding reasons for absence, and the support offered to different staff and new starters. The new QOF framework intends to create a compassionate and inclusive culture under the Quality Improvement workforce and wellbeing indicators​​. To learn more about the changes in the new QOF framework, Enhanced Primary Care provides comprehensive resources on the subject.

The rationale behind this framework is simple yet profound: ensuring the wellbeing of those who dedicate their lives to the health of others. The healthcare sector, particularly primary care, operates under high stress and demand. This stress, if not managed well, can lead to burnout, affecting the quality of care we provide and our overall satisfaction at work. Understanding this framework is not just about compliance; it’s about recognising the importance of our wellbeing in the context of our work and the quality of care we provide to our patients.

The QOF QI Staff and Wellbeing Module is designed to help practices create a compassionate and inclusive culture. It encourages practices to review work-related factors affecting wellbeing, with a focus on workforce planning, flexible working arrangements, reasons for absence, and the support provided to different staff members and new starters​​.

In addition to this, practices are expected to devise and implement a plan to improve outcomes, with the specifics of this plan left to the discretion of each practice. The guidance does, however, provide suggestions such as ensuring stress risk assessments for each role and offering mental wellbeing support, among other things​​.

In this blog post, we’ll delve deeper into the rationale behind this framework, exploring the key components and the potential impact on primary care. We’ll also address the connection between staff wellbeing and quality of care, patient satisfaction, and overall practice performance, offering a comprehensive understanding of why this framework holds significance for our work. So, let’s embark on this journey of exploration and understanding together.

The Rationale Behind the Framework

The Quality Outcomes Framework (QOF) Quality Improvement (QI) Staff and Wellbeing module were introduced to address a clear and urgent need. The rationale behind its implementation stems from the necessity to support and improve the wellbeing of the general practice workforce. With the strains of the pandemic causing additional pressure, and the demands on general practice remaining high, this module aims to provide practices with the means and resources to evaluate how they currently support their staff and to enable the introduction of processes and initiatives that will provide structure and support to staff on a long-term basis​​.

Moreover, this module recognises that practices will be at different points in relation to supporting the wellbeing of their workforce. Thus, the resources provided are designed to be used in a flexible way to meet individual organisational needs​​.

Despite the positives of this initiative, there have been some concerns voiced by those in the sector. For example, Tony Brown, managing partner at Alnwick Medical Group in Northumberland, highlighted the need for better financial support for practices. He argued that a positive culture and team ethos could only go so far in supporting general wellbeing among the team, and that fair compensation was a key factor that was currently lacking​​.

Furthermore, Professor Dame Clare Gerada, President of the Royal College of General Practitioners (RCGP), pointed out that while the focus on GP wellbeing was good, forcing practices to implement audits like this would not solve the real issues, which she identified as workload, especially the workload of GP partners, and a lack of workforce. She suggested a better option would be to ensure doctors have access at the practice level to ‘space for reflection’, which would provide them with the opportunity to explore the emotional impact of particular cases and general workload​​.

The QOF system is set to be reviewed during 2023/24 to become more ‘streamlined and focused’​, reflecting an ongoing commitment to refining and improving the system for the benefit of all involved.

Overview of the QOF QI Staff and Wellbeing Module

The Quality and Outcomes Framework (QOF) has introduced new measures to address the burnout and wellbeing of general practice staff. Under these rules, practices are required to take steps to create a compassionate and inclusive culture. They are asked to conduct a review of all work-related factors that affect staff wellbeing, such as workforce planning, access to flexible working, reasons for absence, and the support provided to different staff members and new starters. Practices then need to draw up and implement a plan to improve outcomes. It’s also recommended to carry out stress risk assessments for each role and consider introducing a mental health champion and encouraging staff to engage with support programmes. However, some practitioners have voiced concerns that these measures might not fully address the real issues, such as workload pressures and workforce shortages​​.

The Impact of Staff Wellbeing on Primary Care

Staff wellbeing in primary care settings is a critical factor that significantly impacts the quality of care, patient satisfaction, and the overall performance of a practice. Below are some of the key ways in which staff wellbeing influences these areas:

Quality of Care: Research has shown that staff wellbeing and the quality of patient care are closely linked. When healthcare professionals are physically and mentally healthy, they are better able to provide high-quality care. They’re more attentive, more effective in their communication, and more adept at making good clinical decisions. Conversely, when healthcare professionals experience burnout or are otherwise unwell, their ability to provide high-quality care can be compromised. For example, burned-out physicians are more likely to make medical errors, have decreased professionalism, and exhibit lower patient adherence to treatment plans.

Patient Satisfaction: Staff wellbeing also impacts patient satisfaction. Patients are more likely to be satisfied with their care when they are treated by healthcare professionals who are engaged, attentive, and satisfied with their own work. If staff are experiencing burnout, stress, or dissatisfaction, it can negatively affect their interactions with patients and lead to lower patient satisfaction. In contrast, healthcare professionals who have high levels of wellbeing are more likely to be empathetic, patient, and responsive to patients’ needs, all of which contribute to higher patient satisfaction.

Practice Performance: The overall performance of a primary care practice, including its efficiency and financial health, is also influenced by staff wellbeing. When staff wellbeing is high, absenteeism and turnover tend to be lower, which leads to fewer disruptions in patient care and less financial strain on the practice. High staff wellbeing also fosters a positive and cooperative work environment, which can increase team cohesion and improve the efficiency of the practice.

In summary, investing in staff wellbeing is not just good for the staff themselves, but it also benefits patients and the overall performance of the practice. It’s a vital aspect of healthcare that deserves attention and investment.

Conclusion

Understanding the rationale behind the Quality and Outcomes Framework Quality Improvement Staff and Wellbeing Module is integral to the progress and development of primary care practices in the UK. This framework aims to create an environment that promotes staff wellbeing and resilience while ensuring that practices continue to deliver the highest standard of care to their patients.

Staff wellbeing plays a pivotal role in determining the quality of care, patient satisfaction, and overall practice performance. Therefore, the introduction of strategies that boost staff morale and reduce work-related stress, as stipulated in the framework, can significantly enhance the performance of a practice.

While the initiative has been met with some scepticism, it is undeniably a step towards recognizing and addressing the underlying issues that have long affected primary care staff. The QOF QI Staff and Wellbeing Module acknowledges the human element in healthcare provision and strives to create a supportive and inclusive culture in all practices.

As we navigate the ever-evolving landscape of primary care, this framework serves as a reminder that our healthcare professionals are our most valuable resource. Protecting their wellbeing not only results in a more resilient workforce but also translates into improved patient care and satisfaction.

The QOF QI Staff and Wellbeing Module provides practices with the tools necessary to evaluate and enhance their support systems, fostering a healthier and more effective primary care workforce. By understanding and implementing this framework, practices can make a significant contribution to the broader goal of enhancing UK healthcare.