status quo of quo vadis? - KCE

38 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76
King and Wilson reviewed the process of development of quality care in Australia and
possible actions to be undertaken. They report health care management issues like
incentives to attract and retain rural GPs, blended payment systems and rewards for
achieving targets (i.e. immunisation). King et al. explicitly list vocational training,
development of standards for general practice, development of a general practice
evaluation programme and the development of an independent accreditation system
owned by the profession. 42
The future role for the Divisions of general practice is gaining importance because of
increasing possibilities for central data collection. An example from the Adelaide
Western General Practice Network is the Practice Atlas. Practice routine data
processed at the level of the Network practices may use quality data as feedback or as
business models and drive innovation in general practice in areas such as practice
business systems, infrastructure/workforce development, and the effectiveness of health
care delivered by health care providers / multidisciplinary teams. 135
2.4.5.5 Learning points and suggestions for Belgium
The Australian accrediting bodies are independent. There are financial incentives of the
government for the general practitioners and general practices. Independent accrediting
bodies assure that data handling is anonymous and secure. Because about 40 percent of
practices took the 3 year cycle, their accreditation system seems feasible. The costs per
GP are moderate so not excluding small practices.
The Royal College has a leadership in quality as it initiates and supports the quality
initiatives. Unfortunately, there is no data on the effects of the system.
General Practice in Australia is well supported by networks. These are the regional
highly effective platforms. They support and interact with practices by providing data
analyses, so that GPs can manage their practice professionally. In this respect the view
as to see general practice as a business offers a way forward. The business aspect refers
to the GPs who need up to date data on their professional behaviour, in order to
answer rapidly to the demands of the public.
Important enablers from the Australian example are:
• A national certification of general practitioners and standards upon which the
certification is based;
• Standards at the practice level to ensure that there is a systematic approach
to safety and quality development;
• System supports, for example regional Divisions of General practice;
• Profession leadership and active government partnerships;
• The concept of seeing general practice as a business where GPs answer to
demands of the public.
The appendix 8 details the Australian indicators for accreditation.
2.5 SUMMARY AND CONCLUSIONS OF THE ANALYSIS OF
FIVE COUNTRIES
Table 4 gives an overview of the quality frameworks in the five countries and Belgium.
GPs in Belgium still often work in single handed practice and have a small practice size.
Apart from this, the working conditions are similar to those of the French GPs. This
review shows that the countries focus on a more practice based approach: the UK,
Australia, the Netherlands and Germany are some examples. Adequate legislation and
funding, IT platforms, independent parties are important issues.