Quality, core values and the general practice consultation: issues of definition, measurement and delivery

Our essay starts by tracing the early history of general practice under the NHS, and identifies patient-centredness and holism as the two concepts which appear to best represent the 'core values' of the discipline of general practice. The difficulties of defining and measuring them are discussed, and in particular the presence of three potentially different components of patient-centredness is recognized. In the second half of the essay, the history of a series of researches carried out in Edinburgh into the definition and delivery of quality at general practice consultations is described, and a new measure of quality called the Consultation Quality Index (CQI) is presented. This measure combines two process measures (consultation length and 'how well the patient knows the doctor') with one outcome measure (patient enablement). Information is presented to show how the CQI can contribute to clinical governance (at practice and at doctor level) and how its use as a research tool offers insights into issues including the influence of ethnicity on patients' evaluation of care, and debate over the optimum size of practices. 'Good' quality in general practice is both hard to define and hard to measure. One reason for this is because effectiveness, a principal component of quality, divides into clinical/technical effectiveness and interpersonal effectiveness. This essay has argued that interpersonal effectiveness - the more difficult component of quality at consultations to define and measure - is, because of the difficulty in operationalizing it, in danger of being lost under the weight of material on the more biomedical domain of clinical effectiveness. © Oxford University Press 2004, all rights reserved.