Safety and quality in primary care: The view from general practice

Abstract

This article aims to provide a general practice perspective on quality and safety in primary health care. As the health care system has evolved over the past 50 years, so have approaches to ensuring it delivers high quality care. Traditional education has been joined by a range of initiatives from psychological, organisational, marketing, epidemiological and social disciplines. Most of these methods are successful in some situations, but need to be tailored to suit the specific context. There is still imperfect guidance in how to do this. Improvements in performance of 5% to 15% seem to be the best that have been achieved in randomised controlled trials. Quality initiatives in Australian general practice have changed considerably in keeping pace with these developments, moving from an educational paradigm to a more whole-of-system approach. They have been introduced or emerged in ways that are sometimes coherent, sometimes not. Australian general practice is a complex system that is hard to imagine organisationally as a well-oiled machine. The Royal Australian College of General Practitioners has developed a quality framework as a conceptual model to help make sense of the current pattern of quality activities and build a strategic awareness to guide future initiatives.