Hostname: page-component-745bb68f8f-g4j75 Total loading time: 0 Render date: 2025-02-05T08:33:22.608Z Has data issue: false hasContentIssue false
  • English
  • Français

Quality assurance in general practice

Published online by Cambridge University Press:  05 December 2011

Richard Baker  and
Oliver Samuel
Richard Baker
Affiliation:
Director, Eli Lilly National Clinical Audit Centre, Department of General Practice, Leicester University
Oliver Samuel
Affiliation:
Medical Audit Adviser, The Royal College of General Practitioners
Get access

Synopsis

This chapter traces the development of quality assurance in general practice over the last quarter of a century. The practical implementation of quality assurance in British general practice is set against experience in other countries. Examples illustrate how ideas for improving care have already been incorporated into normal practice. We describe some of the methods currently in use and speculate about how systems of professional accreditation might become acceptable. Finally we consider the future role of quality assurance in general practice.

Type
Research Article
Information
Proceedings of the Royal Society of Edinburgh, Section B: Biological Sciences , Volume 101: Quality Assurance in Medical Care , 1993 , pp. 123 - 141
Copyright
Copyright © Royal Society of Edinburgh 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baker, R. 1985. Comparison of standards in training and non training practices. Journal of the Royal College of General Practitioners 35, 330–2.Google ScholarPubMed
Baker, R. 1990a. Monitoring of general practitioners' referral rates by Family Health Services Authorities: how practical? Health Trends 22, 53–4.Google ScholarPubMed
Baker, R. 1990b. Development of a questionnaire to assess patient's satisfaction with consultations in general practice. British Journal of General Practice 40, 487–90.Google ScholarPubMed
Baker, R. 1991. The reliability and criterion validity of a measure of patients' satisfaction with their general practice. Family Practice 8, 171–7.CrossRefGoogle ScholarPubMed
Balint, M. 1957. The doctor, his patient and the illness. London: Pitman.CrossRefGoogle Scholar
Barrit, P. W. & Staples, E. 1991. Measuring success in asthma care: a repeat audit. British Journal of General Practice 41, 232–6.Google Scholar
Bowling, A. (1991) Measuring health. A review of quality of life measurement scales. Milton Keynes: Open University Press.Google Scholar
British Thoracic Society. Research Unit of Royal College of Physicians, King's Fund Centre, National Asthma Campaign 1990. Guidelines for management of asthma in adults: 1 – chronic persistent asthma. British Medical Journal 301, 651–3.Google Scholar
Brody, H. 1980. Placebos and the philosophy of medicine: clinical, conceptual and ethical issues. Chicago: University of Chicago Press.Google Scholar
Brook, R. H. et al. (1979). Overview of adult health status measures fielded in Rand's health insurance study. Medical Care 17:(suppl).Google ScholarPubMed
Byrne, P. S. & Long, B. E. L. 1975. Learning to care, 2nd edn. London: Churchill Livingstone.Google Scholar
Byrne, P. S. & Long, B. E. L. 1984 Doctors talking to patients, 2nd edn. London: Royal College of General Practitioners.Google Scholar
Charlton, I., Charlton, G., Broomfield, J. & Mullee, M. A. 1991. Audit of the effect of a nurse run asthma clinic on workload and patient morbidity in general practice. British Journal of General Practice 41, 227–31.Google Scholar
Clyne, M. B. 1961. Night calls. London: Tavistock.Google Scholar
Collings, J. S. 1950. General practice in England today. A reconnaisance. Lancet 1, 555–85.CrossRefGoogle Scholar
Coulter, A., Seagroatt, V. & McPherson, K. 1990. Relation between general practices' outpatient referral rates and rates of elective admissions to hospital. British Medical Journal 301, 272–6.CrossRefGoogle ScholarPubMed
Coulter, A., Roland, M., Wilkin, D. 1991. GP referrals to hospital. A guide for Family Health Services Authorities. Centre for Primary Care Research, University of Manchester.Google Scholar
Crebolder, H. F. 1987. Experiences with self-assessment and peer review among general practitioners in The Netherlands. Australian Clinical Review 7, 32–5.Google ScholarPubMed
Crombie, D. L. & Fleming, D. M. 1988. Practice activity analysis. Occasional Paper 41. London: Royal College of General Practitioners.Google ScholarPubMed
Curtis, S. E. 1987. The patient's view of general practice in an urban area. Family Practice 4, 200–6.CrossRefGoogle Scholar
Dickie, G. L. & Bass, M. J. 1980. Improving problem oriented medical records through self-audit. Journal of Family Practice 10, 487–90.Google ScholarPubMed
Donabedian, A. 1980. The definition of quality: a conceptual exploration. In Explorations in quality assessment and monitoring. Ann Arbor, Michigan: Health Administration Press.Google Scholar
Elder, A. & Samuel, O. (eds) 1987. While I'm here, doctor. London: Tavistock.Google Scholar
Essex, B. & Bate, J. 1991. Audit in general practice by a receptionist: a feasibility study. British Medical Journal 302, 373–6.CrossRefGoogle ScholarPubMed
Fearn, R. 1987. Rural health care: a British success or a tale of unmet need? Social Science and Medicine 24, 263–74.CrossRefGoogle ScholarPubMed
Fitzpatrick, R. 1991a. Surveys of patient satisfaction: 1 – important general considerations. British Medical Journal 302, 887–9.CrossRefGoogle Scholar
Fitzpatrick, R. 1991b. Surveys of patient satisfaction: 2 – designing a questionnaire and conducting a survey. British Medical Journal 302, 1129–32.CrossRefGoogle Scholar
Fleming, D. M., Lawrence, M. S. & Cross, K. W. 1985. List size, screening methods and other characteristics of practices in relation to preventive care. British Medical Journal 291, 869–72.CrossRefGoogle ScholarPubMed
Fraser, R. C. 1981. Audit at work. The future. British Medical Journal 282, 1199–2000.CrossRefGoogle ScholarPubMed
Friedman, L. J. 1962. Virgin wives. London: Tavistock.Google Scholar
Furst, A. L. & Shamba, E. 1989. Methodological issues associated with an audit of stillbirth in a family medicine practice in Israel. Family Practice 6, 177–181.CrossRefGoogle Scholar
Garratt, A. M., Ruta, D. A., Abdallor, M. I., Buckingham, J. K. & Russell, I. T. 1993. The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? British Medical Journal 306, 1440–1444.CrossRefGoogle ScholarPubMed
Gibson, G. 1984. Quality and the medical audit. Canadian Family Physician 1984 30, 2532–4.Google Scholar
Goldberg, D. 1972. The detection of psychiatric illness by questionnaire. Maudsley Monographs 21. London: Oxford University Press.Google Scholar
Grol, R. 1990a. National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards. British Journal of General Practitioners 40, 361–4.Google ScholarPubMed
Grol, R. 1990b. Peer review in primary care. Quality Assurance in Health Care 2, 119–26.CrossRefGoogle ScholarPubMed
Grol, R., Mokkink, H. & Schellevis, F. 1988. The effects of peer review in general practice. Journal of the Royal College of General Practitioners 38, 10–13.Google ScholarPubMed
Grol, R., van Eijk, J., Mesker, P. & Scellevis, F. 1985. Audit: a project on peer review in general practice. Family Practice 2, 219–24.CrossRefGoogle ScholarPubMed
Halpm, S. F. 1991. Radiographic examination of the lumbar spine in a community hospital: an audit of current practice. British Medical Journal 303, 813–15.CrossRefGoogle Scholar
Harris, C. M., Heywood, P. L. & Clayden, A. D. 1990. The analysis of prescribing in general practice: a guide to audit and research. London: HMSO.Google Scholar
Harris, C. M., Jarman, B. & Woodman, E. 1985. Prescribing – a case for prolonged treatment. Journal of the Royal College of General Practitioners 35, 284–7.Google ScholarPubMed
Harris, C. M., Jarman, B., Woodman, E. & Fry, J. 1984. Prescribing – a suitable case for treatment. Occasional Paper 24 London: Royal College of General Practitioners.Google ScholarPubMed
Hart, J. T., Thomas, C., Gibbons, B., Edwards, C., Hart, M., Jones, J., Jones, M. & Walton, P. 1991. Twenty five years of case finding and audit in a socially deprived community. British Medical Journal 302, 1509–13.CrossRefGoogle Scholar
Hopton, J. L., Porter, A. M. D. & Howie, J. G. R. 1991. A measure of perceived health in evaluating general practice: the Nottingham Health Profile. Family Practice 8, 253–60.CrossRefGoogle ScholarPubMed
Horder, J., Byrne, P. S., Freeling, P., Harris, C. M., Irvine, D. H. & Marinker, M. L. 1972. The future general practitioner: learning and teaching. London: Royal College of General Practitioners.Google Scholar
Hunt, S. M., McEwan, J. & McKenna, S. P. 1985. Measuring health status: a new tool for clinicians and epidemiologists. Journal of the Royal College of General Practitioners 35, 185–8.Google ScholarPubMed
Huntingdon, J. 1990. From the front line – audition for an audit. Health Service Journal 19, July.Google Scholar
Irvine, D. 1990. Managing for quality in general practice. Medical Audit Series 2. London: King's Fund Centre.Google ScholarPubMed
Irvine, D. & Irvine, S. 1991. Making sense of audit. Oxford: Radcliffe Medical Press.Google Scholar
Jenkins, D. 1991. Investigations: how to get from guidelines to protocols. British Medical Journal 303, 323–4.CrossRefGoogle ScholarPubMed
Joint Working Group of the Research Unit of the Royal College of Physicians and the British Paediatric Association. 1991. Guidelines for the management of convulsions with fever. British Medical Journal 303, 634–6.Google Scholar
Kemple, T. J. & Hayter, S. R. 1991. Audit of diabetes in general practice. British Medical Journal 302, 451–3.CrossRefGoogle ScholarPubMed
Koppel, J. I. & Pietroni, R. G. 1991. Higher professional education courses in the United Kingdom. Occasional Paper 51. London: Royal College of General Practitioners.Google ScholarPubMed
Levy, M. & Bell, L. 1984. General practice audit of asthma in childhood. British Medical Journal 289, 1115–6.CrossRefGoogle ScholarPubMed
Levenstein, J. H., McCracken, E. C., McWhinney, I. R., Stewart, M. A. & Brown, J. B. 1986. The patient centred clinical method 1. A model for the doctor patient interaction in family medicine. Family Practice 3, 24–30.CrossRefGoogle Scholar
Liverpool Medical Audit Advisory Group. 1991. How was it for you? Thinking about satisfaction with services. Liverpool FHSA, Department of General Practice, University of Liverpool.Google Scholar
Longo, G. 1985. A simple system for auditing quality of primary care screening in school age children. Rivista Italiana di Pediatria 11, 811–17.Google Scholar
McIver, S. 1991. Obtaining the views of users of health services. London: King's Fund Centre.Google Scholar
McWhinney, I. 1989. The need for a transformed clinical method. In Stewart, M. & Roter, D. (Eds) Communicating with medical patients. Newbury Park, California: Sage.Google Scholar
Mant, D., McKinlay, C., Fuller, A., Randall, T., Fullard, E. M. & Muir, J. 1989. Three year follow up of patients with raised blood pressure identified at health checks in general practice. British Medical Journal 298, 1360–2.CrossRefGoogle ScholarPubMed
Mant, D. & Phillips, A. 1986. Can the prevalence of disease risk factors be assessed from general practice records? British Medical Journal 292, 102–4.CrossRefGoogle ScholarPubMed
Metcalfe, D. H. H. 1986. Variations in process in primary care. In Pendleton, D., Schofield, T. & Marinker, M. (Eds) In pursuit of quality, pp. 96–110. London: Royal College of General Practitioners.Google Scholar
Moodie, P. J., Kljakovic, M. & McLeod, D. K. 1989. An audit of a cervical smear screening programme. New Zealand Medical Journal 102, 374–6.Google ScholarPubMed
Morrell, D. 1988. Epidemiology in general practice. Oxford: Oxford University Press.Google Scholar
National Association for Quality Assurance in Health Care. 1991. Quality through teamwork. London: Queen's Nursing Institute.Google Scholar
North of England Study of Standards and Performance in General Practice. 1992a. Medical audit in general practice: 1 – effects on doctors' clinical behaviour for common childhood conditions. British Medical Journal 304, 1480–4.CrossRefGoogle Scholar
North of England Study of Standards and Performance in General Practice. 1992b. Medical audit in general practice: 2 – effect on the health of patients with common childhood conditions. British Medical Journal 304, 1484–8.CrossRefGoogle Scholar
Pendleton, D., Schofield, T. & Marinker, M. (Eds) 1986. In pursuit of quality. London: Royal College of General Practitioners.Google Scholar
Presley, A. P. 1988. Format and content of medical record summaries in 27 training practices. Journal of the Royal College of General Practitioners 38, 26–7.Google ScholarPubMed
Pringle, M. & Stewart-Evans, C. 1990. Does awareness of being video recorded affect doctor' consultation behaviour? British Journal of General Practitioners 40, 455–8.Google ScholarPubMed
Rethans, J.-J., Sturmans, F., Drop, R. & Vleuten, C. Van der. 1991. Assessment of the performance of general practitioners by the use of standardised (simulated) patients. British Journal of General Practitioners 41, 97–9.Google Scholar
Robertson, R. 1991. Primary health services in Ecuador: comparative costs, quality, and equity of care in Ministry of Health and rural social security facilities. Social Science and Medicine 32, 1327–36.CrossRefGoogle ScholarPubMed
Roemer, M. I. & Montoya-Aguilar, C. 1988. Quality assessment and assurance in primary health care. Geneva: World Health Organisation.Google ScholarPubMed
Roland, M. O., Middleton, J., Goss, B. & Moore, A. T. 1989. Should performance indicators in general practice relate to whole practices or individual doctors? Journal of the Royal College of General Practitioners 39, 461–2.Google ScholarPubMed
Roter, D. 1989. Which facets of communication have strong effects on outcome – a meta-analysis. In Stewart, M. & Roter, D. (Eds.) Communicating with medical patients, pp. 183–96. Newbury Park, California: Sage.Google Scholar
Royal College of General Practitioners. 1983. Council policy on quality in general practice. Journal of the Royal College of General Practitioners 33, 523–4.Google Scholar
Royal College of General Practitioners. 1985a. Quality in general practice. Policy Statement 2. London: Royal College of General Practitioners.Google Scholar
Royal College of General Practitioners. 1985b. What sort of doctor? Assessing quality of care in general practice. Report from general practice, 23. London: Royal College of General Practitioners.Google Scholar
Royal College of General Practitioners. 1991. Fellowship by assessment. Occasional Paper 50. London: Royal College of General Practitioners.Google Scholar
Russell, I. & Russell, D. 1990. Statistical issues in medical audit. In Marinker, M. (Ed.) Medical audit and general practice. London: British Medical Journal.Google Scholar
Samuel, O. W. 1990. Towards a curriculum of general practice training Occasional Paper 44 London: Royal College of General Practitioners.Google ScholarPubMed
Sanazaro, P. J. 1974. Medical audit. Experience in the U.S.A. British Medical Journal 1, 271–4.CrossRefGoogle ScholarPubMed
Sheldon, M. J. 1982 Medical audit in general practice. Occasional Paper 20. London: Royal College of General Practitioners.Google ScholarPubMed
Steven, I. D. 1990. Measurement of the process of care. Experiences from The Netherlands and Canada. Australian Family Physician 19, 283–5.Google ScholarPubMed
Stewart, A. L., Hays, R. D. & Ware, J. E. 1988. The MOS short-form general health survey. Reliability and validity in a patient population. Medical Care 26, 724–32.CrossRefGoogle Scholar
Sullivan, R. J., Estes, E. H., Stopford, W. & Lester, A. J. 1980. Adherence to explicit strategies for common medical conditions. Medical Care 18, 388–99.CrossRefGoogle ScholarPubMed
Sunol, R., Delgado, R. & Esteban, A. 1991. Medical audit: the Spanish experience. British Medical Journal 303, 1249–51.CrossRefGoogle ScholarPubMed
Taylor, S. 1954. Good general practice. Oxford: Oxford University Press.Google ScholarPubMed
Teeling-Smith, G. (Ed) 1986. Health, education and general practice. London: Office of Health Economics.Google Scholar
Tseng, R. 1985. An audit of antibiotic prescribing in general practice using sore throats as a tracer for quality control. Public Health 99, 174–7.CrossRefGoogle ScholarPubMed
Vuori, H. V. 1982. Quality assurance in health services. Public Health in Europe Series. 16 Copenhagen: World Health Organization.Google Scholar
Ward, J., Barnes, R. & Bell, S. 1990. Interpractice visits by general practitioners: implications of a pilot project for quality assurance in general practice. Medical Journal of Australia 152, 349–52.CrossRefGoogle ScholarPubMed