Skip to main content Accessibility help
×
×
Home

Models for quality improvement and assurance in English and Welsh primary care

  • Stephen Abbott (a1), Susan Procter (a2) and Nicci Iacovou (a3)
Abstract
Background

Various initiatives have been tried to improve the quality of primary care in England and Wales in the last fifteen years. Such initiatives can be divided into quality improvement (QI) and quality assurance (QA).

Purpose

This paper looks at three contrasting models, drawn from data from 48 semistructured interviews with personnel from three primary care organisations (PCOs): two primary care trusts in England and one Local Health Board in Wales.

Findings

The first model was collegiate, a voluntary doctor-led initiative begun during the period of GP fundholding. The second is clinical governance, a current government-imposed system administered by PCO officers, which has attracted limited engagement from GPs. The third is the Quality and Outcomes Framework of the new GP contract, which was generally described positively, although the process of administering it was experienced as bureaucratic.

Discussion

The three models correspond with three organisational types: networks (which use peer relationships to achieve goals), hierarchy (which use ‘top-down’ requirements and monitoring) and market (which use contracts). Although doctors have traditionally preferred network-style arrangements, the success of these arrangements in sustained QA and QI has been questionable. The importance of hierarchical arrangements is inevitable, given the functions and constitution of PCOs, and the risk that GPs will disengage is similarly inevitable. However, it is important that PCO officers find ways to engage GPs as much as possible in quality initiatives if patient services are to improve.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Models for quality improvement and assurance in English and Welsh primary care
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Models for quality improvement and assurance in English and Welsh primary care
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Models for quality improvement and assurance in English and Welsh primary care
      Available formats
      ×
Copyright
Corresponding author
Address for correspondence: Mr Stephen Abbott, Research Fellow, Public Health and Primary Care Unit, St Bartholomew School of Nursing and Midwifery, City University Institute of Health Sciences, 20, Bartholomew Close, London EC1A 7QN, UK. Email: s.j.abbott@city.ac.uk
References
Hide All
Audit commission. 1996: What the doctor ordered. A study of GP fundholding. London: Audit Commission.
Black, N., Thompson, E. 1993: Obstacles to medical audit: British doctors speak. Social Science and Medicine 36, 7, 849856.
Campbell, S., Sheaff, R., Sibbald, B., Marshall, M.N., Pickard, S., Gask, L., Halliwell, S., Rogers, A., Roland, M.O. 2002: Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance. Quality and Safety in Health Care 11, 914.
Davies, H.T.O., Harrison, S. 2003: Trends in doctor–manager relationships. BMJ 326, 646649.
Degeling, P., Maxwell, S., Iedema, I. 2004: Restructuring clinical governance to maximize its developmental potential. In Gray, A. and Harrisonm, S., editors, Governing medicine: theory and practice. Maidenhead: Open University Press.
Exworthy, M., Powell, M., Mohan, J. 1999: The NHS: quasi-market, quasi-hierarchy and quasi-network? Public Money and Management 19, 4, 1522.
Exworthy, M., Wilkinson, E.K., McColl, A., Moore, M., Roderick, P., Smith, H., Gabbay, J. 2003: The role of performance indicators in changing the autonomy of the general practice professions in the UK. Social Science and Medicine 56, 14931504.
Flynn, R. 2004: ‘Soft bureaucracy’ governmentality and clinical governance: theoretical approaches to emergent policy. In Gray, A. and Harrisonm, S., editors, Governing medicine: theory and practice. Maidenhead: Open University Press.
Goodwin, N., Leese, B., Baxter, K., Abbott, S., Malbon, G., Killoran, A. 2001: Developing primary care organizations. In Mays, N., Wyke, N., Malbon, G. and Goodwin, N., editors, The purchasing of health care by primary care organisations. An evaluation and guide for future policy. Buckingham: Open University Press.
Gray, A. 2004: Governing medicine: an introduction. In Gray, A. and Harrisonm, S., editors, Governing medicine: theory and practice. Maidenhead: Open University Press.
Lam, A. 2000: Tacit knowledge, organizational learning and societal institutions: an integrated framework. Organization Studies 21, 487513.
Light, D.W. 2001: Managed competition, governmentality and institutional response in the United Kingdom. Social Science and Medicine 52, 11671181.
Marshall, M.N., Mannion, R., Nelsonm, E., Davies, H.T.O. 2003: Managing change in the culture of general practice: qualitative case studies in primary care trusts. BMJ 327, 599602.
Mays, N., Wyke, S., Malbon, G., Goodwin, N., editors, 2001: The purchasing of health care by primary care organisations. An evaluation and guide for future policy. Buckingham: Open University Press.
Moran, M. 2004: Governing doctors in the British regulatory state. In Gray, A. and Harrisonm, S., editors, Governing medicine: theory and practice. Maidenhead: Open University Press.
Rhodes, R.A.W. 2000: The governance narrative: key findings and lessons from the ESRC’s Whitehall programme. Public Administration 78, 345363.
Roland, M., Smith, J. 2003: The role and contribution of primary care trusts in quality improvement. In Leatheman, S. and Sutherland, K., editors, The quest for quality in the NHS. A mid-term evaluation of the ten-year quality agenda. London: The Stationery Office, on behalf of The Nuffield Trust.
Sheaff, R., Rogers, A., Pickard, S., Marshall, M., Campbell, S., Sibbald, B., Halliwell, S., Roland, M. 2003a: A subtle governance: ‘soft’ medical leadership in English primary care. Sociology of Health and Illness 25, 5, 408428.
Sheaff, R., Schofield, J., Mannion, R., Dowling, B., Marshall, M., McNally, R. 2003b: Organisational factors and performance: a review of the literature. London: National Co-ordinating Centre for NHS Service Development and Organisation R&D.
Strauss, A. 1978: Negotiations. Varieties, contexts, processes, and social order. San Francisco: Jossey-Bass Publication.
Thompson, G., Frances, J., Levacic, R., MitchellJ., J., editors, 1991: Markets, hierarchies and networks. The coordination of social life. London: Sage Publications.
Walshe, K. 2002: The rise of regulation in the NHS. BMJ 324, 967970.
Wilkin, D., Coleman, A., Dowling, B., SmithK., K., editors, 2002: The national tracker survey of Primary Care Groups and Trusts 2001/2: taking responsibility? Manchester: National Primary Care Research and Development Centre.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed