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Buetow and Wellingham present a comprehensive overview of
accreditation of general practices in New Zealand, and elsewhere, in this
well-written article. They make the very significant point about the
limitations of quality assurance as compared with the more important
performance outcome orientation of continuous quality improvement.
However I am puzzled that they make no reference to the...
However I am puzzled that they make no reference to the major
organisational changes which have occurred within general practice over
the last decade, now involving some 90% of GPs.[2-4] These have a strong
focus on continuous quality improvement. Nor do they make reference to
the major quality achievements in primary care through primary care
organisations, now rapidly evolving into more broadly-based primary
health organisations. Accreditation is only part of this broader primary
health care strategy.
Recent studies of these organisations have shown that visionary GP
leadership, driven to achieve the best possible quality outcomes for
patients, has been the critical factor in these achievements. These have
included the better management of substantial resources associated with
service delivery, including improved pharmaceutical use and prescribing
Practice accreditation has a contribution to make to the quality
strategies of these organisations, which in turn will facilitate
accreditation amongst member practices. But accreditation is only one
part of a comprehensive package. Clinical leadership, within these new
organisational settings, will play a key part in promoting a broader
approach to quality improvement.
(1) Buetow S, Wellingham J. Accreditation of general practices:
challenges and lessons. Qual Saf Health Care 2003; 12:129-135.
(2) Malcolm L. Mays N. New Zealand’s independent practitioner
associations: a working model of clinical governance? BMJ 1999; 319:1340-1342.
(3) Malcolm L, Wright L, Barnett P, Hendry C. Clinical leadership and quality improvements in primary care organisations in New Zealand. Clinical Leaders Association of New Zealand, Auckland, 2002. http://www.clanz.org.nz http://www.moh.govt.nz/
(4) Malcolm L, Wright L, Barnett P, Hendry C. Building a successful partnership between management and clinical leadership: experience from New Zealand. BMJ 2003; 326:653-654.