Involving practice staff and patients in determining standards and priorities in primary care

Abstract

Background: Many British general practices are defining their core services, priorities and standards of care in response to a range of recent initiatives: fund holding in the NHS reforms; consumerism in the ‘Patient's Charter’; strategic targets in the ‘Health of the Nation’; quality assurance in the form of clinical audit; and management planning to gain resources. Usually priorities and standards of care are decided by the senior members of a practice, however, in this study a more consultative approach was evaluated in one practice in the East Midlands of England.

Aim: This study was undertaken to test the feasibility of involving staff and patients in determining priorities and standards in a British general practice.

Method: The practice undertook 33 surveys to audit its standards in a wide range of areas. The results of these surveys were shared with all staff members and patient representatives who were asked to prioritise the areas covered and to choose standards to which the practice should aspire. They were also asked to prioritise the general areas for targeting in ‘Health of the Nation’. A survey of a random selection of 250 adult patients was then undertaken to refine the standards and priorities; these results were discussed at an open meeting of patients before the final consensus standards and priorities became practice policy.

Results: The initial surveys showed that some areas of service were beneath the standards that the senior members of the practice had expected. The consultation process emphasised the need for improvements in six areas of care: appointment availability, giving an explanation to the patients if the doctor was running late, availability of telephone advice, recording of smoking habits, recording of weight, and communicating abnormal pathological results. In terms of the ‘Health of the Nation’ strategic goals of the practice, teenage pregnancy, prevention of ischaemic heart disease and strokes were given greatest priority. Action plans for each of these areas have been designed, publicised and implemented. Doctors, staff and patient representatives reported that this process was informative and effective.

Conclusions: A patient and staff orientated approach to the formulation of practice strategy through the definition of standards and priorities has been shown to be feasible and worthwhile.