Whats quality in GP?

#GPFUQ 4 Whats quality in GP?  You need all of the the following: great access, best treatments, customers satisfied, depth of caring, efficient & effective, fair to all.

The Quality Cube

Lewis Carroll’s Humpty Dumpty understood the words he used.  “When I use a word, it means just what I choose it to mean—neither more nor less.”  Quality has always had a specific vagueness so its not clear what quality means for most people. General Practice only discovered the word Quality in the 1990s and like lots of concepts it was used with no real understanding. Overtime it lost meaning (e.g. the Quality Outcome Framework) but was a worthy endeavour for a dwindling band of enthusiasts (e.g.  the 3% of practices that completed the RCGP Quality Practice Award). 

The Cheshire Cat said “If you don’t know where you are going, any road will get you there.” Quality is not a destination: it’s a journey of aspiration and achievement rather than completion. It will always mean different things to different people at different times.

The problem with the quality journey is that, although we may know what route we think we need to take, we don’t know where we are going, or when we are going to get there. Guides like the English NHS quality and outcome framework (QOF) are like satellite navigation: authoritative and useful but prone to major errors at critical junctions.

We are not there yet, but over the past 20 years our journey has advanced considerably with more aspirations for outcomes and real achievements in the structure and processes for quality in primary care.  Imperfect as QOF is, it is an example of the vertical advance. Examples of other more horizontal advances include the RCGP Quality Practice Award, NHS appraisals, and the RCGP core curriculum. Rapid advance in any direction is usually  fuelled by financial incentives.

A simple approach to quality as we continue on our journey is to run through an A to F checklist on our dashboard gauges to make sure we are still roadworthy. Always check: A, we provide good access to our service, B, the best treatments are available, C, the customers are satisfied with the service, D, we provide a depth of care, E, the service is efficient and effective, and F, we treat everyone fairly. The reality is that we can rarely keep  all the six gauges of quality optimal. We should recognise both effort and achievement. Practices have very different problems and it not fair or useful to use the same gauge readings or scorecards to mark the achievements of different practices.

Lewis Carroll’s advice: “Begin at the beginning and go on till you come to the end; then stop.”