Striving for quality
The word quality is often used and abused, but a good definition can be found on the web (click here). In terms of medicine, everyone would agree that in principle we want to practice high-quality medicine and deliver it well to all of our patients. But that is the easy bit. The hard bit is defining it precisely, making it a reality and continually practising proven and accepted high-quality medicine. This requires funding and therefore making quality measurable in some way. And it turns out measuring quality can be just as tricky as defining it.
The current way of measuring quality in primary care - the Quality and Outcomes Framework - provides a financial incentive to practices to meet targets in specific disease management areas. A new menu of QOF indicators was recently published, as reported in the univadis GP News service (click here). According to the article it "features new items targeting areas such as smoking cessation, hypertension, asthma and fragility fractures". However, these new targets come at the expense of domains such as diabetes and depression, which will be retired.
Another article in the univadis GP News service highlighted the effect of practice features on the achievement of high-quality care. The article (click here) reported findings of a study that concluded: "GP practice size does not influence quality of care." This should stimulate further debate and may inform future policy.
There are many different methods for looking at and measuring quality and these will always prompt debate. I think it is important that we as a profession continue to try to improve our service and we should be open and honest about how we achieve this. Of course, there will be practical limitations on what we can achieve. Constraints such as time, funding, social problems within a practice population and other factors outside of our control may impede our pursuit of quality. But these should not be used as an excuse to stop us reaching the optimum standard of care that we can provide.
From a personal perspective, I am sure that the quality of general practice has improved enormously over the past 20 years. I hope that the improvement has been cost-effective and evidence-based, but these outcomes are difficult to prove. Perhaps we will eventually find indicators that will provide the evidence. In the meantime, the drive towards improving the quality of medicine that we deliver should continue at an ever-increasing pace.
Dr Harry Brown, editor-in-chief Univadis
By Dr Harry Brown