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GPs fail to make impact on quality of care

GPs have made significant progress in improving patient access and organisation of care. But this has had little impact on the quality of clinical care practices provide, a major Government-commissioned

study has revealed.

Practices failed to make any significant improvements over a three-year period in clinical care of asthma, diabetes and mental health ­ all areas covered by the new contract quality framework.

The researchers, at the National Primary Care Research and Development Centre in Manchester, praised GPs for the advances they had made at a time of low morale and with only a modest 3.4 per cent

real-terms increase in practice budgets over the three years.

But they highlighted dramatic variations in the quality of care between practices, with many 'falling short'.

The study compared performance in 1998 and 2001 at 23 GMS practices across England. Practices were scored out of 100 for each element of organisation and care.

The average access score leapt from 73.5 to 86.8, with telephone contact, urgent appointments and access to interpreters all improving.

Organisation of chronic disease management also improved dramatically, from an average of 58.7 to 92.4.

But angina care was the

only clinical area to show

significant progress ­ the

mean score rose from 67.4 to 77.6.

There was no significant improvement in diabetes and asthma care, care of the elderly or mental health care, said a report in the British Journal of General Practice (April).

'Primary care in England is still characterised by variation in care, with significant improvements still possible,' the researchers concluded.

RCGP director of quality Dr Mayur Lakhani said GPs faced a tough task to improve clinical care.

'We can do a lot better but I think people will find quality is hard to deliver and I don't know whether the new contract goes far enough,' he said.

Improving quality hinged on infrastructure funding, said Dr Lakhani, a GP in Loughborough, Leicestershire.

'Diabetes and hypertension control are not going to be easy ­ they will need a new approach, and more concentrated thinking about outcomes,' he said.

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