The question of quality in primary care is a vexed one. According to the King’s Fund:
We have suggested some ways that practices could begin to audit their own practice…. and made recommendations about how the work we have begun could be used as the basis for future development of quality indicators in general practice. While some of these are harder to define we think that many of these aspects of care can be captured by measuring how patients experience care. King’s Fund 2011
The issue is addressed in some detail in the report which includes the following key points:
The key activity in general practice is the consultation. The consultation has been dissected for its component parts by Deveugele et al :
8% Social behavior, 15% agreement, 4% rapport building, 10% partnership building, 11% giving directions, 28% giving information, 14% asking questions and 7% counselling.
Much of what transpires in that consultation can only be reliably interpreted within the local context of that consultation. Therefore any interpretation of the outcome must take into account factors that are not generalisable. That makes it difficult to draw reliable and safe conclusions and by corollary to set benchmarks that apply across every setting.
If the King’s Fund report makes any contribution it is that it highlights the need for further research into interventions that can be deployed within the context of the consultation to reduce diagnostic errors, to understand differences in referral rates and to explain variation in prescribing practice. It also highlights that we have inadequate data on what interventions are best deployed in the context of primary care to support health promotion.
Finally the report makes a very important observation that patients need to be more involved in their healthcare and that the patient experience should be the basis on which we focus on this issue going forward.