BMJ 2001;323:784 ( 6 October )

Primary care

Identifying predictors of high quality care in English general practice: observational study

S M Campbell, research fellow, a M Hann, research associate, a J Hacker, researcher, a C Burns, researcher, a D Oliver, researcher, a A Thapar, general practitioner, b N Mead, research associate, a D Gelb Safran, director, c M O Roland, director. a

a National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, b Department of General Practice, University of Manchester, Rusholme Health Centre, Manchester M14 5NP, c The Health Institute, New England Medical Center, Boston, MA 02111, USA

Correspondence to: S M Campbell stephen.campbell{at}man.ac.uk

Objectives: To assess variation in the quality of care in general practice and identify factors associated with high quality care.
Design: Observational study.
Setting: Stratified random sample of 60 general practices in six areas of England.
Outcome measures: Quality of management of chronic disease (angina, asthma in adults, and type 2 diabetes) and preventive care (rates of uptake for immunisation and cervical smear), access to care, continuity of care, and interpersonal care (general practice assessment survey). Multiple logistic regression with multilevel modelling was used to relate each of the outcome variables to practice size, routine booking interval for consultations, socioeconomic deprivation, and team climate.
Results: Quality of clinical care varied substantially, and access to care, continuity of care, and interpersonal care varied moderately. Scores for asthma, diabetes, and angina were 67%, 21%, and 17% higher in practices with 10 minute booking intervals for consultations compared with practices with five minute booking intervals. Diabetes care was better in larger practices and in practices where staff reported better team climate. Access to care was better in small practices. Preventive care was worse in practices located in socioeconomically deprived areas. Scores for satisfaction, continuity of care, and access to care were higher in practices where staff reported better team climate.
Conclusions: Longer consultation times are essential for providing high quality clinical care. Good teamworking is a key part of providing high quality care across a range of areas and may need specific support if quality of care is to be improved. Additional support is needed to provide preventive care to deprived populations. No single type of practice has a monopoly on high quality care: different types of practice may have different strengths.


What is already known on this topic
Quality of care varies in virtually all aspects of medicine that have been studied

Most studies look at quality of care from a single perspective or for a single condition

What this study adds
Quality of care varies for both clinical care and assessments by patients of access and interpersonal care

Practices with longer booking intervals provide better management of chronic disease; preventive care is less good in practices in deprived areas

No single type of practice has a monopoly on high quality care---small practices provide better access but poorer diabetes care

Good team climate reported by staff is associated with a range of aspects of high quality care



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