Quality improvement
Most general practice professionals are committed to providing a high-quality service to their patients. Yet quality improvement is not routinely embedded in general practice, and various barriers need to be overcome to create a culture in which quality improvement is recognised as central to the provision of good general practice services.
What did we explore?
To inform its final report, the Inquiry panel earlier this year commissioned a discussion paper to review approaches to quality improvement and their current usage in general practice.
Quality improvement in general practice makes recommendations for action at multiple levels of the health system to nurture and support improvements in quality in general practice. The paper's GP authors, Paresh Dawda, Richard Jenkins, and Robert Varnam, are also members of the primary care team at the NHS Institute for Innovation and Improvement.
What have we learnt about quality improvement?
In July 2010 the Inquiry’'s Panel held an expert workshop to discuss the findings of the paper with participants including GPs, Department of Health representatives, health academics and patient groups. Key issues raised in discussion included:
- How quality improvement needs to address 'middle-ranking' general practices as well as the worst performers.
- The appropriate use of incentives to promote quality improvement.
- How to ensure quality improvement involves all members of the practice team.
What's your view?
During the inquiry, we asked for your opinions on this care dimension. You can read the comments submitted below.
Comments
Firstly, the Plan-Do-Study-Act approach is flawed if you don't already know what is wrong. The first step must be to Study; don't plan any changes until you know what needs doing, where it needs to change and by when.
Secondly, every single patient is different and unique. The system must not only cope with variability it must embrace it. The original underlying structure of the NHS recognised this, i.e. primary care managed the variance in patients, selected and referred them on to a variety of specialisms; the specialists achieve improved performance by only seeing relevant patients. Introducing "quality systems" that attempt to reduce variability will be expensive and ineffective. I recognise it is our natures to try and provide equality for all, but this is not an appropriate approach to healthcare provision in primary care. There are better ways.
This report is welcome in that it attempts to review GP engagement in quality improvement. However, in common with so many products from the NHSIII the report is dismissive of the value of clinical audit and the very real progress being made to improve practice in this important discipline within GP settings, and advances other methods as offerring possibly greater value without a shred of supporting evidence. It would be good to see a more balanced and up to date report from a wider perspective.
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