Collaborative improvement in Scottish GP clusters after the Quality and Outcomes Framework: a qualitative study

Huayi Huang, Emily Jefferson, Mark Gotink, Carol Sinclair, Stewart W Mercer, Bruce Guthrie

Research output: Contribution to journalArticlepeer-review


Scotland abolished the Quality and Outcomes Framework (QOF) in April 2016, prior to 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 (n=17) and observations of GP cluster meetings (n=6) in two clusters.

There was uncertainty whether GP clusters should focus on activities generated internally or externally by the wider healthcare system (e.g. from Scottish Health Boards), although the two clusters we observed 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. We observed less evidence of data analytics being championed in these meetings, partly because of barriers 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. Whilst GP clusters are up and running, their impact is likely to be limited without further investment in developing capacity in these areas.
Original languageEnglish
JournalBritish Journal of General Practice
Publication statusPublished - 1 Sep 2021


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