Table 1

Indicators proposed in national framework for assessing performance2 that are most relevant to primary care

Performance indicatorsAvailable data sourceAttributable to health careEvidence that improved indicator value leads to improved health outcomes
Fair access
To elective surgery: rates of CABG and PTCA, of hip and knee replacement, and of cataract replacementYesYesUnclear what ideal rates should be. Only effective if performed on appropriate patients
To family planning services: conception rates for those aged <16YesLimited extentYes
To cancer screening services: % of target population screened for breast and cervical cancerYesYes, but people can refuseYes, though evidence for cervical screening based on observational data
To district nurse contacts: district nurse and assisted district nurse contacts for those aged 75, and district nurse contacts lasting >30 minutes for same age groupYesYesNo
Effective delivery of appropriate health care
% of target population vaccinated and % of all orchidopexies for those aged <5YesYes, but people can refuse vaccinationVaccination, yes; orchidopexy, limited extent
% of target population screened for breast and cervical cancer (as above)YesYes, but people can refuseYes, though evidence for cervical screening based on observational data
Rates of CABG and PTCA, of hip and knee replacement, and of cataract replacementYesYesOnly effective if performed on appropriate patients
Age and sex standardised admission rates for severe ENT infection, kidney or urinary tract infection, heart failure (“avoidable admissions”)YesYes, but patients can self refer to accident and emergency unitsUnclear how
Age and sex standardised admission rates for asthma, diabetes, and epilepsy (“largely managed in a primary care setting”)YesYes, but patients can self refer to accident and emergency unitsUnclear how
Volume of prescribing of benzodiazepines, and ratio of antidepressants to benzodiazepinesYesYesTo some extent
Composite measure of prescribing of combination and modified release products plus “drugs of limited clinical value” and inhaled corticosteroidsYesYesTo some extent
Efficiency
% generic prescribingYesYesNo, but savings made can be invested in effective interventions
Health outcomes of NHS care
Conception rates for those aged <16YesLimited extentYes as this is a health outcome indicator
Notification rates for pertussis and measlesYesYesYes as this is a health outcome indicator
Emergency hospital admissions for people aged >75YesTo some extent, but also reflects social provisionPossibly, but definition of emergency may vary
Rates of emergency psychiatric readmissionYesTo some extent, but also reflects social provisionPossibly, but definition of emergency may vary
  • CABG=coronary artery bypass graft; PTCA=percutaneous transluminal coronary angioplasty; ENT=ear, nose, and throat.

  • The indicators in the other categories—“Health improvement” (deaths from all causes and cancer registrations) and “Patient/carer experience of the NHS”—are less relevant to primary care.