Practice accreditation: the European perspective

Abstract

Accreditation has different meanings in different healthcare settings.1 A complex picture emerges from reviews of healthcare accreditation schemes worldwide but two key features are common — promoting change and professional development.2 Accreditation in primary care settings is generally seen as a way of assessing and benchmarking the performance of general practice care across a broad range of clinical and organisational domains.3 It describes a formal process of self-assessment and external and independent peer review to encourage best practice and can result in recommendations for continuous quality improvement of safety and quality.4 Buetow and Wellingham have suggested five ways in which accreditation may be used.3 These are quality control (mandatory, externally set, minimum predetermined acceptable standards), mandatory regulation (legal or safety standards), continuous quality improvement (to demonstrate excellence above a minimum standard), information giving (to enable comparison between providers by patients and policy makers), and marketing (to showcase services available). Compared with hospital environments, which have a long history of accreditation, general practices have been considered more difficult and less important to accredit.5 However quality problems, caused in part by system failures6 rather than individuals,7 have led to a growing emphasis on the team or organisation as the unit of analysis in quality improvement initiatives. Despite this, with notable exceptions such as the evidence base underpinning the use of the European Practice Assessment (EPA) programme8 there is still a relatively limited evidence base demonstrating the effectiveness, cost effectiveness, and appropriateness of accreditation.9,10,11 A representative from each member country of the European Association of Quality in General Practice (EQuiP) was asked to complete a detailed survey in December 2011 about their country's health system, and practice accreditation scheme, achieving a 100% response rate. Nine countries have practice accreditation …