Quality score no guarantee of best care

The quality framework does not guarantee a high standard of primary care and allows ‘wide differences' between practices scoring similar points.

Ordinary GPs believe the quality framework is not a ‘sufficient measure of quality’ and do not wish to be limited by it, RCGP chairman Professor Mayur Lakhani has told GP.

‘There are big differences between practices achieving 1,000 points. The quality framework gives us a lot of information on performance but the profession is concerned about variations in quality,’ he said.

Despite tensions between the parties, the RCGP intends to stay at the negotiating table with the DoH over introducing a practice appraisal scheme that is a broader assessment of practice quality. Relinquishing negotiations would open the way for ‘a scheme developed by the Healthcare Commission or an American company’, Professor Lakhani said. ‘Do we say we will walk away from a professionally controlled scheme?’

The RCGP continues to insist that any practice appraisal scheme must be voluntary. Professor Lakhani said that recent remarks by health minister Lord Warner that PCTs should be ‘vigorous’ with the contracts of practices that refuse to sign up were ‘unhelpful’ (GP, 10 November). So far, no central DoH funding has been secured to support practices taking part in the pilots of the accreditation scheme. Professor Lakhani believes that practice appraisal can be used to level the playing field in market-driven primary care between GPs, nurse-led practices and private providers.

‘If we are to tackle the issue of the market which people are feeling threatened by, the way we can secure this is to show proper quality standards both through recertification and practice appraisal,’ he said. The RCGP is looking to include different provider types in the practice appraisal pilots.

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