Chasing the tail 1

-  Medium Sized Practice, Semi Rural, 8000+ List Size, England

- March to June 2014


This highly thought of practice is situated in a historic market town around ten miles from a major city. As with other practices in market towns, the population the practice serves features a large proportion of elderly patients who, in addition to having complex health needs, are often isolated and vulnerable. 

The practice is well regarded locally and is seeking to grow both in terms of list size and services offered. It is situated on the boundary between catchment areas which means in some cases there are grey areas in the availability of some support services. The practice has a relatively stable workforce and has had some relatively new appointments to the senior team. The practice has undertaken GPIP as it is looking to meet the increasing demands it is facing through improvement. 


As with all GPIP work areas, the work started with a short briefing from the GPIP expert coach. This was with the team which the practice manager had brought together to work on Chasing the Tail. In this case the team consisted of two GPs, a practice nurse and the practice manager herself.

Deciding on the improvements

The practice undertook three sessions of Chasing the Tail while being supported by their GPIP expert coach. The first session, as an early test for the practice, immediately identified two patients that warranted further examination. 

Considering both patients a total of 18 separate actions were identified. These were transferred to an action plan where clear accountability for who was taking on the action was visible. After the first review, the next two Chasing the Tail sessions covered 24 patients. This essentially meant a rapid six-minute review per patient and requires the practice to keep to the structured approach to ensure the most is gained from the time put in. Across the 24 patients 80% had opportunities to be managed differently identified by the multidisciplinary team - the majority being around a greater holistic nature to their care.

The practice found those patients where only clinical areas were identified as opportunities for improvement as relatively straightforward and quick to review. For those patients where the opportunities were in the areas of mental health and / or social support the review took a little longer. While the reviews were designed to be rapid, both the practice and the GPIP coach took great care when reviewing the patients as many of this high frequency group were also the practice’s most complex and vulnerable patients. 


1 Greater understanding of the activity characteristics of their patient population.
2 Greater understanding of where their capacity is used across the practice.
3 18 improvement actions identified in just the first two 6 minute patient reviews.

4 80% of patients reviewed had opportunities identified
5 A huge buzz from the practice team and GPs competing to become the next lead for improvements!
6 Confidence that improvement methods really can make a huge difference.