General Practice

Bigger is better for primary care

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d1754 (Published 23 March 2011)
Cite this as: BMJ 2011;342:d1754

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  1. Nigel Hawkes, freelance journalist
  1. 1London, UK
  1. nigel.hawkes1{at}btinternet.com

A new report into the quality of primary care finds standards are generally good but highlights the need for more cooperation both between practices and with secondary care, Nigel Hawkes reports

“At its heart, general practice in much of England remains a cottage industry” declares a new report from the King’s Fund—a judgment that, if true, questions the wisdom of putting the entire NHS in the hands of general practitioners. Are “autonomous artisans” who relish isolation and resist comparison with their peers really cut out to be the vanguard of a revolution in quality for the NHS?

The question is well worth asking, though it is less clear that the report provides the answer. General practice is often praised, less often examined. Partly, as the report makes clear, it is because of a lack of adequate data, partly a reluctance to dig too deep into the variations in the quality of care that general practitioners provide. Every GP, it is safe to say, knows of a local colleague who may not be up to scratch. Sometimes, they can even be heard muttering about it. But let’s not go there.

The report, Improving the Quality of Care in General Practice,1 was produced by an independent panel latterly chaired by Ian Kennedy. He was joined on the panel by Michael Dixon, a Devon GP and chair of the NHS Alliance, Steve Field, former chairman of the Royal College of General Practitioners, Ursula Gallagher, director of quality, clinical governance and clinical practice at Ealing Primary Care Trust, and Rebecca Rosen, a GP and senior associate of the King’s Fund.

Performance matters

Why bother? Sir Ian explains: “Most activity in healthcare takes place in general practice, but analysis concentrates on the acute sector. Quality in primary care is somewhat neglected, and very difficult to measure …

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