Understanding quality from a user perspective

Patient articles in professional journals used to be seen as an invasion of territory. Now patients are invited to contribute. We need to share each others’ space if we are to understand one another.So writes Mitzi Blennerhassett, one of the contributors. This is the first in a series of special issues of Quality in Primary Care that we plan to publish as a regular feature. As well as this issue on the ‘Patient Perspectives on Quality in Primary Care’ we are also planning an issue on ‘Commissioning for Quality Improvement’ later this year and next year the ‘Development of Nursing Practice and Scope’, ‘Professional Regulation’ and finally ‘Organisational and Educational Interventions for Quality Improvement’

Letter from the editor

Letter from the edito

Contemplating thinking about thinking

Despite the increasing move to community care, general practitioners sensing that the traditional gatekeeper role is being eroded by other pre-hospital and community health professionals, assailed by private organisations and now even under threat from the acute sector have staked their claim to the central ground of providing interpersonal care, dealing with uncertainty and managing diagnostic complexity. As every general practitioner and ‘House’aficionado knows,diagnosis has always been the most challenging, interesting and difficult aspect of our work,presenting, as it does, many pitfalls and much potential for error

The rise and rise of non-medical prescribing

The reaction from some quarters of the medical profession to the extension of prescribing rights to extended formulary nurse prescribers and pharmacists encompassing the whole British National Formulary is likely to be seen by many as a visceral response to the inherent threat to powerful vested interests in what has been described as the professional monolith of medicine. Although individual nurses and pharmacists and their professional bodies may welcome this move as a just reward for long and hard-fought battles to be recognised as equal partners with the medical profession, the implications of such a profound policy change need to be examined in the cold light of the available evidence, expected positive benefits and potential negative consequences

A voice for quality

I am delighted to take up my appointment as editor of Quality in Primary Care, which I believe will continue to develop as a key journal for our discipline. Although quality may be difficult to define, it is a concept that we are familiar with and aspire to. Mayur Lakhani, my distinguished predecessor, as chair of the Royal College of General Practitioners, leads an institution that stands for quality as well as caring, and will continue to support the work of the journal through the editorial board. Quality is about the pursuit of excellence. It also refers to a distinctive voice and it is therefore appropriate that I begin by expressing my values and vision as editor

Quality in Primary Care in 2007

Editoria

Should the Quality and Outcomes Framework be abolished? No

Head to Head: Steve Gillam (doi:10.1136/bmj.c2710) argues that the general practice pay for performance scheme is not good value for money, but Niroshan Siriwardena (doi:10.1136/bmj.c2794) believes it needs to be improved not remove

Increasing the impact of quality improvement science: learning from the past and changing the future

Editoria

Development and use of clinical performance indicators for ambulance services and prehospital care: a discussion paper for a clinical quality improvement framework for ambulance services

Clinical Performance Indicators for ambulance services should be developed in line with best evidence, in partnership with clinicians and service users, and linked to national structures for knowledge and evidence, clinical expertise and research and development. Their development should be guided by a performance monitoring protocol. Clinical Performance Indicators for ambulance services should be meaningful, measurable and realistic, aiming to address issues that matter to patients and clinicians, to benchmark performance, to reduce variations within and between health services and to bring about improvements in care for patients and users. Indicators should function as part of a planned clinical quality improvement framework that draws on modern improvement principles, methods, tools and techniques. Clinical Performance Indicators for ambulance services should be designed to provide safe, effective, patient centred, timely, efficient and equitable healthcare. Importantly, they should support clinicians and services in providing better care to their patients. Resources should be made available to trusts to undertake such measurements, to contribute to the national data set, to participate in future development and to deliver the aims of quality improvement

Commissioning for quality

Practice-based commissioning (PBC) is no longer the new kid on the block of NHS reform. A direct descendant of the purchaser–provider split conceived by Margaret Thatcher and Alan Enthoven as part of the market reforms of the 1990s, referred to in earlier policy documents and developed in the White Paper on community care, Our health, our Care, our Say it is nevertheless a move towards greater partnership and patient centredness in health care. Whereas general practice (GP) fundholding encouraged individual entrepreneurialism which subsequent primary care groups and trusts were never able to match, PBC, by working directly at the coalface of primary care, does have the potential to lead to rapid transformation more widely