Teri Snowdon

The quality framework developed by The Royal Australian College of General Practitioners is described by Booth in this issue of Australian Family Physician. This article applies the framework to the 'capacity' domain. ThIS article considers both individual and systems approaches to capacity. It focuses on practice capacity and lessons that emerge from general practitioners working with complex and marginalised patient groups. The framework provides a mechanism for assessing policy and implementation initiatives in an Australian context that takes account of the realities of clinical practice.

Quality improvement in health care is a priority. After more than a decade of strategic change in Australian general practice, The Royal Australian College of General Practitioners has developed a conceptual framework for quality improvement. This article provides details of the process that led to the forming of the Quality Framework for Australian General Practice. Quality has dimensions of acceptability, accessibility, appropriateness, effectiveness, efficiency and safety. Domains of professionalism, competence, patient focus, capacity, knowledge and information management, and financing merit consideration at the level of the individual consultation, within the setting of care, and at regional and national levels when designing quality improvement efforts. A quality framework can be used to plan or evaluate quality initiatives, map the current scene, clarify roles and responsibilities and to stimulate broader thinking about quality in general practice.

The quality of care delivered by nurses working in Australian general practices rests on a strong foundation of nursing educatlon and training. A national study of nurses working in general practice was conducted using qualitative and quantitative research techniques to explore their role and educational needs. Results from this research suggest that education for general practice nurses is seen by nurses and General Practitioners to be largely non-formal in nature and is seen by GPs and nurses to be tailored towards general practice nursing needs. Such education is often available locally through general practice support organisations; is strongly focused on National Health Priority Areas and clinical care; and is more appropriate for registered rather than enrolled nurses. The educational opportunities currently available to support nursing in general practice are largely ad hoc and vary in relation to quality, appropriateness and accessibility. Nurses working in general practices in Australia need a system of ongoing training and education to support their responsibilities and foster the development of the position as a viable career option for nurses.

Many strategies have been trialed to recruit GPs to rural areas and to retain them once there. The West Vic Division of General Practice, a rural division in central-western Victoria, has developed and piloted a case management model. Case management is the holistic provision of services to meet an agreed outcome. Usually these processes are used to support clients with chronic or complex care needs. In this instance, the Division recognised that the sometimes puzzling and perplexing world of medical and provider registration, rural communities and the politics of bringing a doctor into a community requires specific skills and support. A dedicated and experienced case manager provides a continuous range of services to support the process from identification through to ongoing support within the community. The project has met with considerable success over the past 18 months, with 17 doctors placed in temporary and permanent positions.

ABSTRACT This article aims to provide a general practice perspective on quality and safety in primary health care. As the health care system has evolved over the past 50 years, so have approaches to ensuring it delivers high quality care. Traditional education has been joined by a range of initiatives from psychological, organisational, marketing, epidemiological and social disciplines. Most of these methods are successful in some situations, but need to be tailored to suit the specific context. There is still imperfect guidance in how to do this. Improvements in performance of 5% to 15% seem to be the best that have been achieved in randomised controlled trials. Quality initiatives in Australian general practice have changed considerably in keeping pace with these developments, moving from an educational paradigm to a more whole-of-system approach. They have been introduced or emerged in ways that are sometimes coherent, sometimes not. Australian general practice is a complex system that is hard to imagine organisationally as a well-oiled machine. The Royal Australian College of General Practitioners has developed a quality framework as a conceptual model to help make sense of the current pattern of quality activities and build a strategic awareness to guide future initiatives.

The Royal Australian College of General Practitioners Guidelines for preventive activities in general practice (the 'red book') are now more than 20 years old. Therefore it is an important juncture to reflect on their appropriateness and implementation, and how they can be improved in future editions. This review analyses the guidelines and their development against criteria identified by the AGREE collaboration to ensure the quality and applicability for use in Australian general practice. The 'red…

The Royal Australian College of General Practitioners Guidelines for preventive activities in general practice (the 'red book') are now more than 20 years old. Therefore it is an important juncture to reflect on their appropriateness and implementation, and how they can be improved in future editions. This review analyses the guidelines and their development against criteria identified by the AGREE collaboration to ensure the quality and applicability for use in Australian general practice. The 'red…