This evidence scan was initially commissioned to inform attendees at the National Summit on Quality in General Practice, held at the Royal College of General Practitioners on 31 July 2014. The theme of the day was 'Sustaining and improving the quality of general practice'.
The scan is divided into three parts:
- Part 1 explores how quality should be defined, drawing upon literature from leading thinkers and organisations in health care and quality improvement.
- Part 2 summarises empirical evidence on what the public think of general practice, and the features they think are important in good quality general practice care.
- Part 3 compiles empirical research about interventions that have been tested to improve the quality of general practice care.
What is quality?
- There is no single definition of quality in general practice.
- An appropriate conceptualisation of quality depends on what the information will be used for.
- Contextual factors such as location, policy priorities, discipline, demographics and measurement approaches all influence what is valued as good quality.
- However, there is a lot of consistency within frameworks about quality in health care, with a focus on patient experience, clinical effectiveness and safety.
- A question remains about whether these three domains are the most important for general practice, and whether other components such as generalism and holistic care need to be included.
What does ‘good quality general practice’ look like to patients?
Research suggests that the top factors influencing whether people believe they have experienced high quality care are:
- good interpersonal skills from clinicians and receptionists, including communication and empathy
- easy access to care, including convenient appointments with a familiar clinician
- being involved in care processes, including sharing in decisions and being supported to self-manage.
Aspects such as technical skills and safety are less often mentioned as key components of quality, perhaps because patients take these for granted.
What interventions improve quality in general practice?
Interventions can be divided according to whether they are targeted at the level of the patient, the practitioner or the wider practice or system. Some interventions may span more than one of these levels, but this distinction provides some clarity about the main focus. Interventions that have been shown to be effective at each of these levels include the following:
- Patient level: improving access, increasing the duration of consultations, seeing the same clinician over time, patient education, patient access to records, gaining feedback from patients and using technology and other support tools.
- Practitioner level: training in quality improvement methods, interprofessional learning, audit and feedback, educational outreach visits, improvement collaboratives, decision support tools, nurse-led services and increased staffing levels.
- Practice/system level: providing a wider range of services, quality improvement projects, telehealth, clinical audit, significant event analysis, electronic tools and improving data collection and error reporting.