Standardised consultations in primary care

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b152 (Published 18 March 2009) Cite this as: BMJ 2009;338:b152
  1. Peter Croft, head of centre,
  2. Mark Porcheret, general practitioner research fellow
  1. 1Arthritis Research Campaign National Primary Care Centre, Keele University, Staffordshire ST5 5BG
  1. p.r.croft{at}cphc.keele.ac.uk

    Are beneficial for some conditions, but should their extent be limited?

    How much of primary care should be standardised? The drive for evidence based quality has precipitated guidelines and protocols aimed at setting standards and reducing variation in clinical care. Yet the personal and continuing approach to care, typified by the general practice consultation, sits uneasily with such requirements for uniformity. Some commentators predict that changes in clinical practice towards care based on more formulaic protocols will lead to the disappearance of the family practitioner.1 Others have highlighted the practical and conceptual barriers that general practitioners face when asked to implement the increasing number of guidelines and decision tools.2 However, the central concern driving the idea of standardisation is the frequent gaps and variations between evidence and practice. In the linked randomised controlled trial (doi:10.1136/bmj.b421), Ravaud and colleagues assess the effect of standardised consultations about body weight and physical exercise in patients with osteoarthritis of the knee.

    Standardisation of procedures is not uncommon or new in primary care. Routine systematic coding of morbidity and activity has transformed consultation records in general practice. Efficient …

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