New Contract for General Practitioners

A Bold Initiative to Improve Quality of Care, but Implementation Will Be Difficult

Published in: BMJ, British Medical Journal, v. 326, no. 7387, Editorials, Mar. 1, 2003, p. 457-458

Posted on RAND.org on January 01, 2003

by Paul G. Shekelle

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This week a proposed new contract between the NHS and general practitioners contains an initiative to improve the quality of primary care that is the boldest such proposal on this scale ever attempted anywhere in the world.1 The proposal spells out 76quality indicators in 10clinical domains of care, 56in organisational areas, four assessing patients' experience, and a number of indicators for additional services. The proposal furthermore sets targets for performance that will be accompanied by increased payments to providers. Like any bold proposal this one offers the promise of a quantum change in performance rather than an incremental one. To get there, however, will require a great deal of work by all involved and may come at the price of other aspects of primary care being left out of this quality framework. The net effect on primary care will therefore depend on how this initiative is implemented and the follow on work of the NHS and general practitioners at building on what works and a willingness to discard or change what does not. What led to this initiative? There is much evidence that certain aspects of primary care are not being carried out at optimal levels.

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