Identifying predictors of high quality care in English general practice: observational study

Objectives To assess variation in the quality of care in general practice a nd identify factors associated with high quality care. Design Observational study. Setting Stratified random sample of 60 general practices in six areas of En gland. Outcome measures Quality of management of chronic disease (angina, asthma i n adults, and type 2 diabetes) and preventive care (rates of uptake for imm unisation and cervical smear), access to care, continuity of care, and inte rpersonal care (general practice assessment survey). Multiple logistic regr ession with multilevel modelling was used to relate each of the outcome var iables to practice size, routine booking interval for consultations, socioe conomic deprivation, and team climate. Results Quality of clinical care varied substantially, and access to care, continuity of care, and interpersonal care varied moderately. Scores for as thma, diabetes, and angina were 67%, 21%, and 17% higher in practices with 10 minute booking intervals for consultations compared with practices with five minute booking intervals. Diabetes care was better in larger practices and in practices where staff reported better team climate. Access to care was better in small practices. Preventive care was worse in practices locat ed in socioeconomically deprived areas. Scores for satisfaction, continuity of care, and access to care were higher in practices where staff reported better team climate. Conclusions Longer consultation times are essential for providing high qual ity clinical care. Good teamworking is a key part of providing high quality care across a range of areas and may need specific support if quality of c are is to be improved. Additional support is needed to provide preventive c are to deprived populations. No single type of practice has a monopoly on h igh quality care: different types of practice may have different strengths.