General practice lies at the heart of the new coalition government's plans for reform of the NHS in England. The flagship policy of GP-led commissioning will seek to transfer real budgets to groups of practices in order to galvanise clinical leadership and bring commissioning decisions closer to patients.
This change is likely to result in larger GP-led clinical collectives and federations with more direct accountability for ensuring that high-quality, cost-effective care is delivered to local communities.
When you set this idea alongside plans for practice accreditation, GP revalidation, a revised Quality and Outcomes Framework (QOF), and the benchmarking of performance through balanced scorecards and patient-reported outcomes, you cannot help but reach the conclusion that general practice is undergoing a quality revolution that is likely to significantly challenge and change the nature of its work.
It is because of this increased emphasis on quality improvement in general practice that we commissioned an Inquiry into the Quality of General Practice in England. A key emphasis has been to understand whether quality can be measured across a range of care dimension, how it can be measured and what approaches really lead to sustained quality improvement.
A series of research papers that we commissioned to support the Inquiry are now being published. These have already been debated at a series of seminars with GPs, practice nurses, NHS executives and patient representatives. We hope that you will engage in further debate by leaving your comments on each discussion paper online.
So what have we learnt so far? It is clear that care quality in general practice is generally thought to have improved in recent years, but that more could be done to address the significant variations in care quality that exist. However, most of the studies we commissioned found it hard to make any definitive judgement on care quality in general practice due to a lack of data and information.
A common finding to emerge is that existing measures (such as QOF indicators) are important levers for quality improvement yet do not capture the true essence of care quality. For example, important issues such as care co-ordination and continuity are left unmeasured and undervalued. The Inquiry has spent time working out whether and how this can be redressed. Many of the research papers show that quality of care suffers most when it is poorly co-ordinated, for example, between general practices and other providers.
If general practice is at the heart of the government's reform agenda, then more needs to be done to enable those working in it to embrace and nurture quality of care. A common response from our seminars was that practices need the time and skills to carry out local audit and peer review to investigate and monitor quality.
As the Inquiry begins to consider these findings, your feedback – particularly if you work in or with general practice – will be important to inform their deliberations on the current state of quality in general practice, how and where this could be improved, and what this means for the future. We invite you to join the debate.