From cottage industry to post-industrial care? The RCGP response to the King's Fund report on the quality of care in general practice

Abstract

> ‘Most of the care provided by general practice is good … however, there are variations in performance and some quality gaps which need to be addressed …’ With these words, the King's Fund report sets out the challenge for general practice in the 21st century.1 This report is a product of an independent inquiry and represents the most extensive examination of quality in general practice for many years. In his foreword, Sir Ian Kennedy describes general practice as ‘not given to self-reflection and self-challenge’. Little evidence is provided for this contention. General practice has been at the forefront of the profession in promoting reflective practice as part of its specialist training programmes. General practice was an early adopter of clinical audit and significant event analysis to improve clinical care.2 Not for the first time, preconceived ideas about general practice have run ahead of the evidence, and such assertions should not go unchallenged! The recommendations of the report have been categorised into five key themes as the basis for the Royal College of General Practitioners’ (RCGPs’) response. General practice must ‘own’ the quality agenda and provide effective clinical leadership. College members are encouraged to consider professional leadership roles over the course of their careers and the RCGP is committed to providing opportunities to support them.3 The RCGP Leadership Programme helps GPs develop skills in thinking strategically, leading, persuading, and challenging colleagues, and working collaboratively. Awareness must be developed among GPs and their colleagues of the extent of the variation in clinical practice and the ‘gaps’ in quality. Quality improvement needs to be understood as a key component of the ‘core business’ of general practice. All professionals must be more open to scrutiny by their peers and by their patients, and quality data from practices should be widely available. …