Quality indicators for general practice: which ones can general practitioners and health authority managers agree are important and how useful are they?

Background The aim of the study was to assess the face validity of quality indicators being proposed for use in general practice by health authorities . Method A national survey of health authorities was carried out to identify quality indicators being proposed for use in general practice. A two-stage Delphi process was used to establish general practitioners' (GPs') and heal th authority managers' views on the face validity of identified indicators. A total of 240 separate indicators identified by health authorities and th e NHS Executive as potential markers of the quality of general practice car e were assessed. Indicators related to access, organizational performance, preventive care, care for a small number of chronic diseases, prescribing a nd gatekeeping. The subjects were a purposive sample of 47 health authority managers and 57 general practice course organizers. Results Thirty-six indicators received median validity scores of 8 or 9 out of a maximum possible score of 9. Of this set, 83 per cent was rated ident ically by both groups of respondents. Prescribing and gatekeeping indicator s generally received low validity scores. Conclusion Acceptable face valid indicators were identified for all domains except gatekeeping. However, the indicators rated by the sample do not cov er all aspects of care. No indicators were proposed for use by health autho rities relating to effective communication, care of acute illness, health o utcomes or patient evaluation. Although it is possible to develop indicator s of general practice care which have face validity in the view of both GPs and managers, these will be very partial measures of quality. In the indic ators used in this study, no explicit distinction was made between indicato rs designed to assess minimum standards with which all practices should com ply, and indicators which could be used to reward higher levels of performa nce. Failure to separate these will result in antagonism from practitioners to quality improvement initiatives in the NHS, and a failure to engage the profession in improving quality of care.