Family Practice Vol. 20, No. 5, 617-618
© Oxford University Press 2003
Book Review |
Quantifying quality in primary care.
Peter Graves. (264 pages, £24.95.) Radcliffe Medical Press Ltd, 2003. ISBN 1-85775-599-5.
GP in North London and negotiator for the British Medical Association with responsibility for quality matters
As one who has spent the best part of a decade trying to achieve measures of quality for UK general practice, I was hoping to find a work that could bring the uninitiated to a point where they could critically review their work and improve their practice. This book does not fulfil that hope.
The author works for the UK government and tends to quote their official documents uncritically rather than making many references to the very extensive literature on the subject. There are innumerable papers about how to measure quality, yet the author creates his own scheme without much linkage to other sources of guidance. Apart from some mapping to the quality activity of the Royal College of General Practitioners, he has tried to create a quality agenda in his own head without any practical demonstration that his version of quality testing works. It is unfortunate that he does not produce any evidence of peer review or testing of his own work. As a result of this uncritical approach, he has failed to set it in the context of real life. What worries me most is his scoring system; the linear scoring used throughout the book is simplistic in the extreme and makes no link to prevalence or ease of delivery. Some things are worth much more than others (because they are either harder to do or more important) and he singularly fails to recognize this.
I was struck by his exercise of prejudice about what constitutes quality care—the promotion of breastfeeding is a typical example. The author rewards those practices that have breastfeeding counsellors and is critical of those that do not. He also wants meetings for everything, protocols for many things and expects GPs and their staff to do ‘over 75 checkups’ when there is no evidence that they have any value and the Department of Health is abandoning them in the draft new UK GP contract.
This proposed contract has a quality framework that is evidence based, has been extensively tested, is not dependent on government prejudice and does not waste time on meetings to get a score on a points system that is simplistic. But the author of this book works for the body charged with monitoring the NHS. I hope they do not use his book as the device to check whether GPs are doing their jobs properly.
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