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We collude to be average

GP consortia need to have a culture where they are not afraid to ask hard questions about the quality of care they are commissioning, says Dr Paul Zollinger-Read

Last week's BMJ had yet another article on the quality of care our elderly patients receive; coming only a few weeks after the Health Ombudsman's report that looked into ten case studies of elderly care, which by anyone's descriptions were shocking.

We are now entering into a period of transition from PCTs as commissioners, to consortia. History tells us that it is at these times that we must be extra vigilant to ensure that our patients receive the highest level of quality and safety of care.

Last week I attended an event in the East of England that focussed on just this transition issue. I know I've touched on this issue before however this issue is so important every one of us needs to think about what our part in this is, both at the individual and also at the organisational level.

At the event we heard from the CEO of Mid Staffs NHS Trust about the journey they had been through and the painful lessons they had learnt. It was clear that leadership was absolutely up there as the most important attribute to ensuring safety and quality; it's the leadership that defines the culture of the organisation. A culture that needs to be curious and ask questions, seek information and then act on that information.

Safety and quality has to be more than a reactive process it needs to be the foundation of the organisation and for this to be effective needs to extend across organisational boundaries.

One of the interesting dilemmas is our use of benchmarking data. We often seek information to reassure ourselves that we are OK. 'We're average; and there are many worse than us'…..curiously reassuring. This debate was played out in the work on C. difficile when you used to hear 'what is an acceptable level of C Diff?' I glad to say we've moved on and now everyone agrees one case is one too many. So we need to get out of the relative data trap and focus on the absolute - any complications, every episode of poor care or avoidable deaths are one too many.

So what can we do to ensure we commission the highest quality of care? GPs are ideally placed to triangulate the rich source of information that the many millions of consultations provide each week; each giving a clue, a hint to the quality of care locally. We need to ensure that this information is rigorously brought together at the practice level and then at consortia level and married together with other information's sources such as patient feedback and serious incident data from providers.

However, we cannot always rely on feedback and there are a couple of other areas that I think are crucial. Firstly joint audits between primary and secondary care; clinicians jointly reviewing services, planning and undertaking this work together. Ensuring a sense of 'owning the process' is crucial and helps to move this difficult issue away from a confrontational approach to a supportive and developmental one

The second idea is to get out and walk the wards; be they in a mental health trust a hospital, or going out and about with a community nurse. There is no better way to observe first hand what is happening. So cancel a meeting and get out! This provides invaluable feedback.

It is all too often the case that we collude to be average; there is no room for relative comparisons here. Each adverse incident or poor episode of care is one too many.

Dr Paul Zollinger-Read is a GP and director of GP commissioning at NHS East of England

Click here for more from Dr Paul Zollinger-Read Notes from the Dark Side: Safety and Quality of Care

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