status quo of quo vadis? - KCE

60 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76
The GPs trust those parties and that trust is crucial to ensure the validity of the data
collected. In Australia, the professional bodies initiated third parties that receive
financial means from the government: they are responsible for creating the IT platforms
and coaching practices. In the Netherlands, a national organisation run by the GP’s
association is the dedicated third party.
The independent trustworthy body can address many tasks.
• They implement the procedures to collect and analyse the data using IT
platforms: repetitive measurements are necessary to assess and further
improve the level of quality;
• They provide data handling and feedback reports to the practices;
• They offer coaching and support for the practices: feedbacks and coaching of
the practices are crucial for a successful quality cycle: they support the
formative processes and reinforce learning activities.
• They may issue accreditation certificates when targets for indicators are
reached (and eventually calculate the ‘fee for performance’);
They communicate aggregated and anonymous data to the Health Authorities,
anonymous data for research purposes and aggregated data to the Glems/LOKs in
order to promote quality activities in the peer review groups.
In Belgium, a trustworthy independent body could be initiated in collaboration with the
scientific professional bodies and/or with regional organisations of GPs. As an
illustration, some regions have successfully built partnerships and IT platforms to
organise large scale after-hours services 145 . They have an expertise in the management
of information technology and feedback. They could for example play a role in the data
collection and feedback to the practices.
The composition of this independent body is a major point of discussion that should be
handled by the stakeholders mentioned in the point 4.3.1.
4.3.10 Financial support
The Belgian Health Authorities have an interest in initiatives for improving quality of
care. In general practice, the Authorities invested in the initiatives described above i.e.,
‘accreditation’, feedback and GLEMs/LOKs (see chapter 4.1). The sum invested in the
accreditation procedure is estimated to be at least 73 791 271 euros with few
evaluation of the impact on the quality of care. There is still a lot of work to be done
for quality improvement in Belgian general practice and that needs financial support. The
Authorities also recently provided a lump sum of 6 800 000 euros specifically for quality
development initiatives in hospitals, showing ongoing interest for quality 146 .
New quality initiatives need preliminary pilot tests before any further investment. As a
comparison, pilot experiences also preceded the implementation of large scale afterhours
care services. 145
The financial support of the GP practice should consider the investment for
participating in quality initiatives and the results of the assessment. First, the work
relating to the process should be rewarded (e.g., introduction to quality concepts and
quality work, data entering, working on the quality cycle with a tutor). Secondly,
complementary fees could be an incentive for reaching targets for quality indicators. As
stated above, the development of a balanced set of indicators that mirrors the scope of
general practice is important (e.g., preventive tasks, patient satisfaction and clinical
indicators for chronic diseases). The UK experience shows that risks are linked with
target payment including a less holistic approach, a possible patient selection and a focus
on well-paid activities to the detriment of less measurable quality items. The
interpretation of the measurement has to take into account specific contextual factors
like working in deprived areas.