Call for 'radical changes' in measurement of quality in general practice
By Lilian Anekwe
A major investigation by the King's Fund into general practice has found 'wide variations in performance' and urges the Government to review the way GP performance is assessed.
The final report from the think tank's lengthy and wide-ranging inquiry into general practice - which has lasted two years - described the profession as a ‘cottage industry in need of modernisation'.
The authors have identified ‘considerable scope for improvement' in many areas of general practice, including referrals, prescribing, diagnosis and the management of long-term conditions.
It called on the Government to launch a ‘comprehensive review of indicators for general practice' to weed out those that are no longer ‘fit for purpose' in the new era of GP commissioning.
The Department of Health should also draw up a core set of national indicators for use by practices and consortia to measure specific aspects of care, the report recommends.
The King's Fund called on GP consortia to take up the baton of assessing, monitoring and encouraging quality improvements, after finding previous attempts to gauge the quality of general practice – by methods including balanced scorecards – had only been used patchily and inconsistently across the country, and had ‘stifled' local attempts by GPs to benchmark their own standards of care.
The report, published today, found: ‘There is a need for a comprehensive review of indicators for general practice to consider their fitness for purpose in supporting both the assessment of quality within general practice and the new commissioning role for GP consortia.
‘We recommend that a core set of measures are developed nationally for use locally by practices interested in improving particular aspects of care.
‘While in some areas there need to be national standards and data to support an assessment of quality across all practices, we believe there is also much greater scope for the use of local audit and qualitative analytical methods as a driver of quality improvement.
‘Reliance on externally imposed quality measures, and the use of periodic large-scale measurement for comparison against benchmarks, have stifled alternative approaches that might encourage local ownership of problems and their solution.
‘We conclude that there is a strong case for simplifying and rationalising these activities in order to reduce wasteful duplication of effort and avoid confusion. This would potentially reduce the growing burden on commissioners and general practices and create a more accessible, transparent and coherent picture of quality.'
It said a shift in mindset and culture was needed amongst GPs to encourage them to embrace change and see delivering and improving quality as a key part of their job, along with a shift from the role of gatekeeper to that of 'navigator' in the new world of GP commissioning.
Sir Ian Kennedy, chair of the inquiry panel, said: ‘The first challenge is that general practice needs to adapt to the challenges around them and the expectations of patients of them.
‘We say that radical changes are called for and a new deal for patients is needed. GPs need to take the responsibility for their own practices in terms of identifying and reducing the variation we have identified.'
• Technology is available that could transform the way patients interact with general practice. However, general practice has been slow to adopt it
• There are wide variations in the rate of referrals between practices. The evidence suggests that a significant proportion of referrals made in general practice may not be clinically necessary.
• There are opportunities for quality improvement to address inefficient or inappropriate prescribing
• Improvements in care for patients with long-term conditions have been made over the years, particularly for those with diabetes, but the evidence suggests that recommended care is not reliably delivered to all patients –especially to those with multiple long-term conditions
• There is evidence to show that in recent years it has been more difficult for patients to see a preferred GP, raising concerns about continuity of care.
• There is an urgent need to accelerate the work to establish federations of practices, and to bring isolated practices more formally into larger provider organisations or networks. The advent of GP commissioning will make this a necessity.
Source: Improving the quality of care in general practice