• clinical governance
• general practice

Several arguments can be readily raised against monitoring outcomes in primary care. Many patients attending primary care have minor self-limiting illnesses, and the only outcomes that might be of interest for monitoring would be significant adverse events such as drug reactions. At the practice or practitioner level the numbers of patients with significant disorders are small, and distinguishing the impact of variations in quality of care from case mix and random variation is difficult. Research evidence is often incomplete and the relationship between the process of care and its outcome is not well established. The interval between the delivery of healthcare interventions and eventual outcome can be many years, as in the case of illness prevention strategies. Primary care is provided by teams, and it is frequently impossible to ascribe a particular outcome to the care provided by an individual doctor or nurse. Some family doctors …