Intended for healthcare professionals

Observations Life and Death

Who’s complacent now? The King’s Fund on general practice

BMJ 2011; 342 doi: (Published 13 April 2011) Cite this as: BMJ 2011;342:d2254

Response to Iona Heath's article from the independent panel of The King's Fund's inquiry into the quality of general practice

Iona Heath criticises the independent inquiry into the quality of
general practice in England, commissioned by The King's Fund, for
publishing 'out of date' evidence1. Specifically, she asserts that there
is 'mounting evidence' to show that glycaemic control in type 2 diabetes
patients at the QOF target of <7% risks increasing mortality.

However, the evidence she cites does not support this argument for
two reasons: first, the degree of reduction in glycated haemoglobin could
not be implied to explain the higher mortality observed in the reported
study; second, the higher mortality was observed amongst those patients
managed to a target of <6% and not <7%2. The inquiry is thus clearly
justified in using a QOF standard, based on current best-practice
guidance, to demonstrate variation in performance.

Moreover, and contrary to what Heath goes on to say in her article,
the inquiry's report firmly asserts the importance of continuity of care.
The vision it sets out for the future of general practice clearly has this
theme at its heart.

The report also makes quite clear that a 'new deal' for patients is
required in the level of their engagement and involvement with general
practice. This may be a challenging task, but one that general practice
needs to confront. It is clearly not acceptable to simply 'blame the
patient' as Dr Heath implies.

The purpose of the inquiry's report was to provide an assessment of
the state of quality in general practice (good but room for improvement)
and to create awareness of variations in care quality. In particular, the
report sets out an agenda for supporting general practice in quality
improvement and how this will need to evolve in future.

While some may dispute individual elements of the analysis or the
recommendations, the feedback we have had from professional groups
supports the broad thrust of the report. Indeed, it was directly welcomed
at its launch by the Royal College of General Practitioners themselves.

We are disappointed that Dr Heath, as President of the RCGP, chose to
pick apart individual aspects of the report but offer no alternative view
or suggestions about improving quality. Instead she seems intent on
discrediting it - and The King's Fund - for reasons that are not made

Yours sincerely,

Sir Ian Kennedy, Chair of the independent panel. Emeritus Professor
of Health, Law and Ethics at University College London and Chair of the
Independent Parliamentary Standards Authority
Dr Michael Dixon, Chair, NHS Alliance
Professor Steve Field, former Chairman of Council of the Royal College of
General Practitioners
Ursula Gallagher, Director of Quality, Clinical Governance and Clinical
Practice, NHS Ealing
Dr Rebecca Rosen, Senior Fellow, The Nuffield Trust.

Competing interests: No competing interests

20 April 2011
Ian Kennedy
Chair of the panel
Emeritus Professor of Health, Law and Ethics at University College London