Raising the quality of drug treatment: beyond the national standards

Clinician’s influences

Dr Chris Ford GP and Clinical Director SMMGP4th West Midlands Conference

What do we mean by quality An essential and distinguishing

attribute of something or someone

Degree or grade of excellence or worth

A characteristic property that defines the apparent individual

Quality in health care

The achievement of optimal physical and mental health through: accessible, cost-effective care that is based on best

evidence is responsive to the needs and preferences of patients

and populations is respectful of patients' families, personal values and

beliefs

Quality and cost effectiveness of care delivered in primary careA systematic review of quality of care in general practice

concluded: ‘The published research in the field presents an incomplete

picture of the quality of clinical care’

But a substantial number of well-designed studies exist comparing care by GPs to that of specialists, which show ‘no significant difference in quality of care and health outcome for care delivered by GPs even when substituted for secondary care specialists.’

‘Primary care physicians are more likely than specialists to provide continuity and comprehensive care resulting in improved health outcomes’

Quality in drug treatment The achievement of optimal physical and mental

health through: accessible, cost-effective care that is based on best

evidence is responsive to the needs and preferences of patients

and populations is respectful of patients' families, personal values and

beliefs But quality of care vary with point of view and

role who may be patient, clinician, purchaser, or manager

Descriptions of quality also depend on: clinical setting, patient expectations, and severity

illness

Quality depends on point of view Depend on who you are:

Patient Clinician Purchaser Manager

Also depend on: clinical setting Patient expectations Severity illness

What have we had to help us? Frameworks

QuADs, DANOS, MoC, TOPs Clinicians

Clinical guidelines Roles and responsibilities Appraisals Toolkit RCGP Certificate

What have been the constraints? Target driven

culture Risk aversive

Is the new agenda going to help us?

Changing directions Less resources End of target

driven culture Back to local

priorities PCTs out PBC in Where to next?

Language: old out, new in Delivery/roll-out Investment Demand side Top-down Target Regional/national State Strategy Evidence based Partnership agreements Stakeholder Active centre

Implementation Spending Supply side Bottom-up Payment-by-results Local Society Business Plan Principles based Post-bureaucratic state Social Responsibility Departments

What do we have as clinicians to help us? Listening to patients Education /

Knowledge RCGP Certificate

Code of practice Clinical guidelines Roles and

responsibilities Appraisals Toolkit

What the toolkit says? Competencies

necessary to meet roles and responsibilities

1. Joint working2. Assessment &

testing3. Treatment4. Support & HR5. Care Plans6. Policy

Clinician influences on quality Patient-centred

care Competent

compassion Flexibility Firm but fair

boundaries

What else do we need to do to ensure quality?

Fight for patients rights

Leadership Ensure that

practice informs policy and commissioning

Working together Impossible to do

alone

Summary

Change is coming An opportunity Need to ensure quality in ourselves Continue to fight for quality services for our

patients

Thank you

chrishelen.ford@virgin.net