THE CONCEPT OF QUALITY
While overwhelmingly quality is presented by policymakers as measurable and as meeting predefined top-down targets, we argue that quality in general practice is multiform and multifaceted. Quality is a notion that is hugely difficult to pin down in all its richness and complexity and countless attempts have been made at defining quality in health care. Definitions range from the more concrete (quality as access and effectiveness for instance,1) to the abstract (quality as purely a social construct rather than an objective entity2). Therefore, there exists a clear challenge of unifying the practical realities of general practice with subjective norms into one concept.
MONITORING BY NUMBERS
The coalition government’s agenda preaches values of openness and transparency through improved information capture to raise the quality of patient care.3 The type of information favoured for this purpose tends to take a numerical form, usually lending itself more quickly and readily to comparisons across services and strategic decision making than its ‘softer’ qualitative counterparts. The dominant method of data facilitation in general practice is of course the Quality and Outcomes Framework (QOF), which has been with us since the introduction of the new general medical services (nGMS) contract in 2004. There is no doubt that measurement plays a key part in enabling focused quality improvement initiatives, for instance by identifying need in specific patient populations, and on a wider-level is likely to be a valuable tool in supporting commissioning decisions. QOF monitoring has also resulted in the creation of the largest general practice database in the world, prompting research around processes and outputs and their relationship to outcomes in general practice.
However, increasingly, monitoring is viewed as instrumental to quantifying quality. In the face of austerity, top down monitoring feeds into …