What we do
We combine practical, embedded quality improvement with rigorous programme management to deliver measurable change in primary care, social care, and the interfaces between them.
Quality improvement facilitation
We work on-site with practice teams to identify where time is being lost, redesign the workflows that cause it, and build the team's capability to sustain changes independently. Our approach is grounded in Lean Six Sigma methodology, but it's practical and hands-on — we sit in duty rooms and observe real operations rather than requesting data extracts from a distance. Typical engagements run from 12 to 20 weeks of embedded support, covering areas such as care navigation, electronic repeat dispensing, document management, patient access pathways, and long-term condition reviews.
Primary careProgramme management and oversight
We manage multi-practice improvement programmes on behalf of commissioners, providing the coordination, reporting, and quality assurance that keeps large-scale transformation on track. This includes commissioner liaison, facilitator mentoring, cohort-level learning events, and the kind of structured governance that ensures programme outcomes are documented and demonstrable. We've managed programmes commissioned by NHS England and RCGP, working through specialist delivery partners.
Commissioners & ICBsService transformation
Beyond individual practices, we design and deliver improvement programmes that work across organisational boundaries — between primary and secondary care, between health and social care, and between commissioners and providers. Our hospital team improvement methodology applies Lean Six Sigma to discharge pathways, care transfers, and demand management with quantified cost avoidance and capacity release.
Health & social care systemsEvidence of impact
Every engagement we deliver is measured. These aren't estimates — they're calculated from timed observations, patient volumes, and verified workflow data.
Lincolnshire — Practice Level Support programme
5,455 hours/year releasedFour practices received embedded quality improvement support over 20 weeks, targeting document management, electronic repeat dispensing, care navigation, and long-term condition review pathways. One practice alone released 2,868 annualised hours through measured workflow changes across clinical and administrative tasks.
London — Document workflow transformation
90% time reductionA detailed audit of clinical correspondence processing revealed a practice was spending 6.7 hours daily on secondary care document handling. Through workflow redesign and role redistribution, processing time was reduced to 40 minutes per day. A parallel audit of 100 secondary care letters found 60% lacked action summaries and 85% had no documented GP action, identifying over 13,000 misdirected patient enquiries annually.
South Yorkshire — GP capacity release
670 minutes/week savedAt a 30,000-patient practice, document workflow redesign alone released 670 minutes of GP time per week — equivalent to approximately £40,000 annually in clinical capacity. This was achieved through targeted changes to how incoming correspondence was triaged, actioned, and filed, without additional technology or staffing.
West Yorkshire — Telephony and access
52% increase in call capacityReconfiguration of telephony systems, call handling protocols, and appointment booking workflows increased weekly call capacity from 1,508 to 2,302 calls while maintaining answer rates above 80%. A separate practice improved its answer rate from 45% to 62% through process changes alone — no new phone lines, no new staff.
Derbyshire — Targeted rapid improvement
360 hours/year from 4 initiativesFour focused improvement initiatives at a single practice — electronic repeat dispensing, care navigation, medication review alignment, and document handling — collectively released 360 annualised hours. One initiative eliminated 4,000 duplicate annual transactions by consolidating long-term condition and medication review processes.
Clinical correspondence quality programme
A dedicated research and improvement programme addressing one of primary care's most persistent operational challenges: the volume, quality, and safety impact of clinical correspondence.
General practices across the country are drowning in clinical correspondence that arrives in inconsistent formats, with unclear expectations, and without adequate systems to process it safely. The consequences are real: missed actions, delayed care, wasted GP time, and thousands of patients contacting the wrong service because their letters don't tell them what happens next.
We're building an evidence base across multiple sites to quantify these problems and develop practical, scalable solutions. Our audit methodology measures processing times, error rates, and workflow impact at the practice level, producing data that commissioners can act on.
This programme sits at the intersection of patient safety, operational efficiency, and national policy — aligning with the NHS Red Tape Challenge and the findings of recent HSSIB investigations into the primary-secondary care interface. We're exploring academic collaborations to develop a formal research application alongside the service improvement work.
About
AmiHC is led by Paul Friend, an independent quality improvement specialist and programme manager with deep operational experience in NHS primary care and health and social care systems. Since 2022, Paul has delivered embedded QI facilitation and programme management across more than 34 general practices in eight NHS regions, working on programmes commissioned by NHS England and the Royal College of General Practitioners, delivered through specialist partners including Conexus Healthcare, Shil UK, and Develop Consulting.
What sets Paul apart is the way he works. Rather than consulting from a distance, he embeds with practice teams — typically four days a week during intensive phases, scaling back as capability transfers. He sits in duty rooms, observes real workflows, measures actual task times, and builds changes around what he sees rather than what he's told. Every improvement is measured, every outcome is documented, and every engagement leaves teams with the knowledge to sustain changes independently.
Our associates
AmiHC draws on a network of experienced associates who bring specialist expertise to each engagement as the work requires. This means we can scale to meet programme demands without carrying overhead — you get the right people, for the right work, at the right time.
Lean and Six Sigma
Certified practitioners who bring structured improvement methodology to complex operational challenges, from frontline process redesign through to organisation-wide transformation.
Data and analytics
Analysts who can extract meaning from operational data, build dashboards, and produce the evidence base that commissioners and boards need to act on.
HR and workforce
Specialists in workforce planning, role redesign, and the people side of change — essential when improvement work involves new ways of working or skill-mix changes.
Finance
Professionals who can model cost avoidance, build business cases, and ensure that efficiency gains translate into demonstrable financial outcomes.
Practice management and operations
People who have run practices and understand the day-to-day realities of primary care operations, bringing credibility and practical insight to every engagement.
Clinical and operational leadership
Senior leaders who can provide strategic oversight, clinical governance, and the organisational authority that large-scale programmes require.
What people say
"The most impactful element is as an experienced extra pair of hands. His presence has helped to progress the work at a pace and keep these teams participating when they may have found it easier to drop out."— NHS England
"Paul has been instrumental in helping us get the practice back on track. He has been an incredible support to us over the past few months."— Practice Manager, Wakefield
"Having Paul as a mentor has been fantastic — his support helped us turn ideas into reality. The protected time each week made a huge difference."— Practice Manager
Work with us
Whether you're commissioning a service improvement programme or looking for an experienced programme manager to join your team, there's a way to work together.