status quo of quo vadis? - KCE

58 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76
The role of each stakeholder can not be precisely defined from this scientific project but
the scheme suggests that scientific bodies are important for the development of tools
and indicators whilst other stakeholders are important for the development of IT
infrastructure. Patient organisations may become more important in the debate on
quality as is observed in surrounding countries.
4.3.4 Emphasis on the GP practice
Four of the five countries studied focused on quality development at the level of the
practice. This is today one important missing link in general practice quality
development in Belgium. As group practices and primary care teams are emerging, the
practice and practice team level will become more important.
Although there is a trend towards group practices, most GPs in Belgium today still
work in single-handed practices. Any quality development project should target both
types of practices, keeping in mind the equity principle i.e., all patients must benefit from
quality development initiatives.
4.3.5 Internal and external drivers for change
An essential point is to show to individual GPs what they win from the quality
development approach in their practice. The foreign experiences show the need for a
careful balance between the formative and summative use of any future scheme for
quality development. The UK example largely shows the unintended consequences of a
summative approach ´we come to see how you are doing´ (see chapter 2.3.6). The
Australian approach is essentially different and addresses the general practice as a
business. Here the essential question is ´how well am I doing?´ The available literature
does not give any firm answer about the optimal balance between internal and external
drivers for change.
4.3.6 Organizational capacity of the practices for quality development;
manpower and IT
The EPA study highlighted the lack of capacity of the practices. Most Belgian GPs, in
particular when working in single-handed practices, do not benefit from any ancillary
support (e.g., secretary, practice assistant). Many tasks needed for a quality
development project require an extra effort from the GP him/herself. This may hamper
the feasibility of quality development initiatives in the practice.
The introduction of GP models that include ancillary workforce within the practices is a
way forward. In The Netherlands, the practice assistant plays a major role in quality
activities and the GP can also delegate simple medical acts to him/her. In the UK, all GP
practices, even single-handed, have medical and administrative personnel to support the
GP in his/her medical and administrative work. These examples call for a
reconsideration of the current organisation of the Belgian GP practices: they have to
switch from a model where the GP performs all tasks to a model where he can delegate
specific tasks to co-workers who have different skills.
IT infrastructure is essential for the collection of clinical indicators but in Belgium IT
systems effectively supporting quality development projects are not yet available. The
current IT systems use different software packages that are not systematically adapted
to routine data extraction. 140 Entering data should be easy for the practitioner and
ancillary personnel and integrated in his/her usual electronic medical record to optimize
the data collection 141,142 . All software packages need to allow data extraction for
measuring quality indicators. The IT packages used in general practice should therefore
adhere to these conditions before their certification. A more formal approval is
therefore rapidly needed. The UK and Dutch experiences show that IT support and a
financial aid to the practices allow the development of a performing IT infrastructure in
a short period of time.