Primary Care

Introduction

In the UK, most patients experience of healthcare is within primary care. Primary care is the term for the health services that play a central role in the local community; GPs, pharmacists, dentists and midwives. Every citizen should have the best possible access to these services.

General practitioners are responsible both for providing primary care services and for organising referrals for specialist care. Consequently, the medical records held by general practitioners include details of all diagnoses and prescribed drugs, in many cases extending from birth. In an increasing number of general practices, these records are held in electronic format and are potentially available for extraction and analysis. Electronic data from general practice therefore offer unique opportunities to plan and monitor health services, measure the quality of care provided by the National Health Service, and undertake population-based research.

The introduction of a new GP contract with a Quality and Outcomes Framework requires general practices to routinely record detailed information on clinical management. QMAS is a national web-based software tool developed for implementing the new GP contract. Data from practices are aggregated to maintain patient confidentiality, and for every practice a set of quality (QOF) scores is calculated.

Participation by practices in the QOF is voluntary, though participation rates are very high, with most Personal Medical Services (PMS) practices also taking part. Through the QOF, general practices are rewarded financially for aspects of the quality of care they provide. QMAS ensures consistency in the calculation of quality achievement and disease prevalence, and is linked to payment systems.

This means that payment rules underpinning the new GMS contract are implemented consistently across all systems and all practices in England. Users of data derived from QMAS should recognise that QMAS was established as a mechanism to support the calculation of practice QOF payments. It is not a comprehensive source of data on quality of care in general practice, but it is potentially a rich and valuable source of such information, providing the limitations of the data are acknowledged.

There are several specific primary care databases. The most widely used is the General Practice Research Database (GPRD), which has mainly been used for epidemiological and health services research, providing information on trends of disease prevalence, and prescribing patterns.

Further information regarding QOF and other sources of primary care data can be found in the report 'A users guide to data collected in primary care in England' below.

Highlight figures

In 2009/10, practices in England achieved an average of 936.9 points, 93.7% of the 1,000 points available. This compares with an average achievement of 95.4% of available points in 2008/09. The reduction in the average level of achievement is attributable to changes to the QOF in 2009/10, especially the change to the Patient Experience domain.