1. Raising the quality of drug treatment: beyond the national standards Clinicians influences Dr Chris Ford GP and Clinical Director SMMGP 4 th West Midlands Conference

2. 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

3. 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

4. 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

5. 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

6. Quality depends on point of view Depend on who you are: Patient Clinician Purchaser Manager Also depend on: clinical setting Patient expectations Severity illness

7. What have we had to help us? Frameworks QuADs, DANOS, MoC, TOPs Clinicians Clinical guidelines Roles and responsibilities Appraisals Toolkit RCGP Certificate

8. What have been the constraints? Target driven culture Risk aversive

9. Is the new agenda going to help us?

10. Changing directions Less resources End of target driven culture Back to local priorities PCTs out PBC in Where to next?

11. 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

12. 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

14. What the toolkit says? Competencies necessary to meet roles and responsibilities 1.Joint working 2.Assessment & testing 3.Treatment 4.Support & HR 5.Care Plans 6.Policy

15. Clinician influences on quality Patient-centred care Competent compassion Flexibility Firm but fair boundaries

16. What else do we need to do to ensure quality? Fight for patients rights Leadership Ensure that practice informs policy and commissioning

17. Working together Impossible to do alone

18. Summary Change is coming An opportunity Need to ensure quality in ourselves Continue to fight for quality services for our patients

19. Thank you chrishelen.ford@virgin.net