DoH has 'systematic' plan for practice quality improvement

The government has issued a document offering PCTs more than a dozen ways to ensure 'continuous quality improvement' in general practice.

The DoH paper, Improving quality in primary care, proposes using tools including QOF, balanced scorecards and clinical dashboards to measure practice performance and motivate them to 'raise the bar'.

'We know that individuals within the NHS are already adopting the approaches needed to promote continuous quality improvement,' it says.

'The next challenge is to apply these methods universally and systematically.'

The document suggests that 'over time' the balance between 'national and local investment' must change, to allow PCTs to tailor services better to their populations.

But it warns them not to create 'a culture in which providers expect additional payment before implementing good or effective clinical practice'.

It says QOF was intended to 'provide initial incentives that embed evidence-based care within general practice'.

GPC deputy chairman Dr Richard Vautrey said the document was 'effectively a summary' of policies already underway.

But he added: 'It shows that there has been such a plethora of initiatives that it is no wonder practices feel bureaucracy is weighing down on them.'

He criticised measures such as balanced scorecards, which excluded elements that were hard to quantify.

'We need to value and recognise the art of general practice,' he said. 'The time spent with a patient who has marital problems, or serious depression. That is very difficult to measure. But it needs to be recognised that good care depends on that.'

Dr Vautrey said the QOF had become a victim of its own success: 'Now everyone wants to get their particular bit into it.'

The document also calls on PCTs to choose local indicators that are 'outcomes focused rather than quantity focused'.

But Dr Vautrey rejected this, arguing that 'processes are often as important, if not more so'.

However, the document also warns PCTs of the need to 'engage' with clinicians 'to achieve continuous improvements in quality and reduce unnecessary pressures and costs in secondary care'.

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