Intended for healthcare professionals


New contract for general practitioners

BMJ 2003; 326 doi: (Published 01 March 2003) Cite this as: BMJ 2003;326:457

A bold initiative to improve quality of care, but implementation will be difficult

  1. Paul Shekelle, professor of medicine, University of California Los Angeles (
  1. Greater Los Angeles Veterans Affairs Healthcare System, 11731 Wilshire Boulevard, Los Angeles, CA 90073 USA

    News p 465

    This week a proposed new contract between the NHS and general practitioners contains an initiative to improve the quality of primary care that is the boldest such proposal on this scale ever attempted anywhere in the world.1 The proposal spells out 76 quality indicators in 10 clinical domains of care, 56 in organisational areas, four assessing patients' experience, and a number of indicators for additional services. The proposal furthermore sets targets for performance that will be accompanied by increased payments to providers. Like any bold proposal this one offers the promise of a quantum change in performance rather than an incremental one. To get there, however, will require a great deal of work by all involved and may come at the price of other aspects of primary care being left out of this quality framework. The net effect on primary care will therefore depend on how this initiative is implemented and the follow on work of the NHS and general practitioners at building on what works and a willingness to discard or change …

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