Their limitations suggest the need for more appropriate measures

General practice pp 94, 98

In its white paper on the English NHS the government has emphasised the need for an accountability framework against which to measure its objectives. A consultation document has suggested that health authorities should use performance indicators such as hospital admission rates as a measure of the quality of primary care.1 Yet two papers in this week's BMJ cast further doubt on hospital admission rates as a good measure of general practice performance.

In the United States high hospital admission rates for chronic diseases like asthma, hypertension, congestive cardiac failure, chronic obstructive airways disease, and diabetes have been associated with lack of access to a primary care physician.2 In the United Kingdom substantial variation exists in admission rates among both health authorities 3 and general practices.4 Variation in general practitioner referral rates is correlated with subsequent variation in elective admissions.5 Given the continuing rise of both elective and emergency admissions in the United …