Chasing the tail 2

-  Large / Urban / Multi-Site Practice / 20000+ List Size, England

-  March - June 2014


This practice is a large, urban practice across three different surgeries. It is a well respected practice that consistently delivers high quality care and experience for its patients. A large proportion of its 20000 + patients are registered to its university surgery. This adds a layer of complexity and variation on demands to its services. Its other surgeries offer services to a more typical demographic spread, facing the pressures from the increasing prevalence of lifestyle related conditions and an ageing population. 

The practice is professional and ambitious. It is not only looking to grow its range of high quality services offered, but also its list size. The practice believes in tackling the pressures it faces through improvement and so were keen take up GPIP. GPIP was commissioned by the practice’s CCG - a CCG that is keen to support practices with the demands they face, through building improvement capability and confidence.  


Collecting the data

The practice created three Queries in their practice data system, producing three sets of data each with differing levels of detail. These Queries took around an hour to perfect. Together with their expert GPIP coach they then exported the data into MS Excel to produce graphs for analysis. 

Analysing the data

The practice worked up to a valuable meeting with all of their senior team. To ensure this meeting was well used the data extract and early analysis was done beforehand. The first piece of analysis looked at the top 23 of the most high frequency patients on their list.

This analysis served to create a strong case for change.

Deciding on the improvements

The improvements associated with Chasing the Tail are centred around the patient, the practice and strategic practice level. 

The practice looked at what the data was telling them first. This meant looking at the graphs and taking the organizational learning from them. At a high level there were three vital pieces of learning for the practice:

  • That they have a large proportion of patients who have not attended in the past year (approx. 40%). Although it was expected to some extent, the number was not. This identified challenges on two levels. The first being that the practice needed to engage in dialogue with those patients not attending, and identify those at risk or who should be using additional services such as smears. Secondly, that due to the large number of patients in this zero attendances group, it would pose a business risk if there was a significant shift in their activity. This is because the practice is already flat out and has already received funding for these patients. Thus the practice identified that it needed to explore this group of patients in a deliberately cautious fashion.
  • That the age of a significant proportion of the patients who are medium to high attenders (30+ attendances / year) was much lower than first thought. 
  • That if the practice could look at reducing its overall activity (65k+ contacts / yr) by just 5% (through internal challenge of the frequency of some patient groups) it would provide the opportunity to increase the practice list size by around 1150 patients – without the need to increase resource. Thus potentially bringing in £74k extra revenue.




Large group of zero visit patients now targeted for communication. 


Practice to explore the provision on Mental Health and Eating Disorder support for the newly identified patient group of med / high attending yet young patients.


Opportunities for greater levels of supervision identified following initial patient review. 

4  Greater awareness of business issues across the whole senior practice team. 
5 Renewed awareness of the need for regular multi-disciplinary reviews of patients.


Continuation on the improvement area:


The practice has agreed an action plan to continue looking at Chasing the Tail. 


The practice is meeting as a senior team to discuss the most appropriate forum for continuing the Chasing the Tail meetings. 


The practice is now more confident and is better equipped to run System 1 queries and analysing them in MS Excel. 


The practice now sees the value of using data to provide structure to improvement work.