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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 care
A 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