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Improving the quality of care in general practice

Report of an independent inquiry commissioned by The King's Fund

General practice is often regarded as the bedrock of the English health care system. Surveys consistently report high levels of trust in GPs and good levels of patient satisfaction with the services they receive in general practice.

However, other than data available through the Quality Outcomes Framework and the GP Patient Survey, very little information is published on the quality of care in general practice.

It was for this reason that The King's Fund set up, in April 2009, an independent inquiry into the quality of general practice in England. The aim of the inquiry, which was conducted by an independent panel of experts and chaired by Sir Ian Kennedy, was to help to support the work of general practice and to provide a guide to ensure that quality is at the heart of the service that it offers to patients.

Improving the quality of care in general practice is the report of the inquiry; it represents the most extensive review of quality across general practice carried out in recent years. Its work was informed by specially commissioned research and analysis of routinely available data across a range of aspects of general practice including: core elements of day-to-day practice - for example, diagnosis, referral and prescribing; non-clinical aspects of quality - for example, access to care and patient engagement; and areas where the role is shared with others - for example, maternity and end-of-life care.

The recent root -and-branch reforms of the NHS also have profound implications for the future of general practice, in particular the dual role it is being asked to play as both commissioner and provider of care that will mean GPs taking on responsibility for costs as well as outcomes of care. The timing of the inquiry's report is therefore propitious. General practice is at centre stage and quality must be the watchword.

In terms of the current quality of care, the inquiry concluded that the majority of care provided by general practice is good. However, there are wide variations in performance and gaps in the quality of care that suggest there is significant opportunity for improvement. Practices need a lot of support to encourage them to seek out and address variable performance, including: appropriate data and information; skills development; protected time; and appropriate rewards for excellence (as well as consequences for poor performance). Policy-makers, regulators, commissioners and professional bodies could all do more to create a better environment that supports general practice in its quest for quality.