A recent paper published by the NHS Institute for Innovation and Improvement, The Next Leg of the Journey: how do we make High Quality Care for All a reality?, identified key success factors for implementation of the next stage review, amid concern that many NHS organisations lack capability.

The paper highlighted two organisations, in Sweden and in the US, that have been successful in programmes of improvement and transformation that can be used as lessons for how to implement change in the NHS.

However, it overlooks an example of systematic, large scale improvement much nearer to home - that of UK general practice.

Since 2000 more than half of all general practices have actively participated in improvement programmes on access, coronary heart disease, diabetes and chronic obstructive pulmonary disease.

This was improvement on a colossal scale, recognised by Don Berwick of the Institute for Healthcare Improvement as constituting the largest systemic improvement in modern history.

Ruth Kennedy, chief executive, and Dr David Lyon, clinical adviser, Improvement Foundation