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Review - How useful was the King's Fund study?

Dr Chris Mimnagh says it failed to adequately highlight areas where GPs already deliver high-quality care.

No surprise that the report recommends listening to patients' views (Photograph: Jason Heath Lancy)
No surprise that the report recommends listening to patients' views (Photograph: Jason Heath Lancy)

After a gestation period lasting 18 months, the King's Fund last month published the findings of its inquiry into improving the quality of care in general practice.

Given that 18 months is as long as a whale's gestation period but four months short of an elephant's, is the inquiry 'a whale of an idea' or the elephant in the room of primary care?

Much of the supporting documentation was on the King's Fund website before the official launch. The focus on access as the cornerstone of quality was predictable: after all, what good are practices' services if you cannot access them?

The 169-page report is, nevertheless, worth the read.

Most of it focuses on an appraisal of the current state of general practices: primary care was not under the microscope. It acknowledges that quality is a complex subject to analyse and goes on to pick up on variations which are not overtly stated as being 'bad' but simply damned with faint praise.

'Most people, most of the time, report good access to care. However, there are wide variations across all dimensions of access,' the report states.

No major surprises
The report does not suggest that variation is good or bad, just that it is there and at odds with good access to care. There are no surprises in its recommendations for the future of general practice. It calls for practices to:

  • Benchmark against similar practices.
  • Listen to patient's views and collaborate with colleagues to improve services.
  • Be motivated to appraise their own performance.

The report did not give enough examples of case studies. For example, my PCT has a balanced scorecard owned by GPs working via a community of practices, and has been around for six years. Every practice has a patient participation group.

I do not believe we are unique in having 100 per cent practice-based commissioning sign up.

Soon we will also have two GP consortia pursuing a clear quality agenda. We no longer have isolated singlehanded GPs and are fully reimbursing the costs of practices undertaking RCGP practice accreditation.

In the last financial year, our practices delivered some of their best performances ever against contract. In other areas, receiving the King's Fund report might be a case of outing the elephant in the room. However in a health community like ours, the elephant in the room has been working for us for years.

  • Dr Mimnagh is a GP in Liverpool and medical director of NHS Knowlsey

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