Occasional Paper 10 - The Royal New Zealand College of General ...

Day 2 – Quality Improvement
Themes:
1. Are indicators useful? What are the internationally transferable concepts? Frameworks: QOF and Aiming for
Excellence – what are the benefits if any?
2. So your results look bad: what to do next?
3. Aiming for Excellence version 3
4. Forum – Exploring the interdependency of quality initiatives that impact on general practice
5. What’s in it for me?
6. Martin Roland – reflections from the two days
Quality Improvement
Building on the lessons from day one, day two focused on quality measurement, and its application by a range of
organisations for the purpose of measurement and improvement. In particular, how the UK health system uses measurement
for incentivisation, its limitations and relevance for New Zealand.
Martin Roland led the second day with a presentation on the Quality and Outcomes Framework, covering development
and how it was used to negotiate the UK GP contract. The framework focuses mainly on chronic disease management,
with little on the clinical care of acute medical problems, or on communication between doctors and patients.
It represents a major gap in the overall assessment of quality of care in general practice. He noted that NZ
should consider the impact of a QOF type framework and identify important principles relevant to its own setting, as
adoption of another framework may not apply or be relevant. The way forward should be a well considered pathway,
to ensure important aspects toward improvement in the NZ setting are measured.
Frameworks are important, and that each is unique. The group discussed the impact of QOF on NZ initiatives such as
the PHO Performance Management Programme and the other frameworks such as the College’s Aiming for Excellence.
There are important lessons for NZ general practice and the health sector, for example:
• Should the NZ College reconsider its structure for the Aiming for Excellence framework?
• What are the pros and cons of including clinical outcome indicators in Aiming for Excellence?
• What would a framework for NZ look like and how would we select/develop clinical indicators?
Room for improvement? What do you do next?
“So you’ve measured your chosen aspect of care, and there appear to be problems in your care.”
The group was taken beyond the theory to the practical application of quality through people, processes and tools.
Measuring quality using quality indicators is only the first step to improving quality. There is no single method of
© THE ROYAL NEW ZEALAND COLLEGE OF GENERAL PRACTITIONERS / Summary of Proceedings 2008 9