Since 1990, the changes introduced in UK general practice, such as fund holding and national incentives, have altered the process of care. Audit, defined as "the systematic critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for patients", is one method of monitoring change and raising standards. Presents a successful co-ordinated audit in Warwickshire, 1991-1993, involving 53 general practices. Highlights and influence of attitudes and communication within practices on the success of audit strategies. Associates aspects of practice culture, such as team working and decision-making processes with successful audit. Postulates six descriptive practice types, largely related to culture factors. Suggests that if cultural factors within practices are identified, external assistance with audit may be more focused and effective.
Critical incident technique for auditing in primary care The report by Redpath et all of facilitated critical incident discussions in primary care in County Durham, after deaths by suicide, represents a valuable contribution to a difficult area. However, the authors do not refer to a similar method, significant event auditing, which was based in part on critical incident research. A research study evaluated the effect of implementing team based case discussions in practices in Manchester and Lincolnshire. The participating primary care teams included discussions of suicide and self harm among various other clinical and organizational events. These authors found that groups familiar with traditional audit were better able to start conducting such discussions. External facilitation, for instance by audit support staff, seemed to be helpful, especially in dealing with sensitive areas. They commend the method as being suitable for reflection and peer support after emotionally disturbing events, as well as offering insights into the quality of care delivered by the practice team. The Royal College of General Practitioners, encouraged by Pringle, require significant event discussions in the portfolio of audits expected for Fellowship by Assessment of the College.4 We have endeavoured to promote significant event auditing in Warwickshire, starting with a questionnaire survey of all 79 county practices in November 1996. Out of 203 total respondents from 49 practices, including general practitioners, nurses, and practice managers, 94 (46%) wished to know more about the methods. Only three practices seemed already to be performing appreciable event auditing. We have since organised a study day, attended by 23 varying team members from 15 practices, and we are now offering practices initial facilitation of meetings.
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