Professional regulation in primary care: the long road to quality improvement

<p>In the current climate of advances in medical knowledge,changes in the pattern of illness and pressures ofdemand, many countries are seeking to strengthentheir primary care services to improve quality. Thesefirst-line services provided by a range of professionalswithin local communities are seen as being best placedto prevent, or intervene early in, the illness processin ways that are cost-effective.The challenge togovernments lies not only in channelling resourcesinto primary care, but also in ensuring that these areused to raise standards of care internationally. Oneconsequence has been a rise in the regulation of clinicalwork, an area where in the past professionals haveexercised considerable autonomy and been relativelyfree from external scrutiny.The case for increased regulation is a consequence not only of governments’ desire to curb healthcare spending, but also of such factors as research on unexplained variations in practice, the growth of more evidence-based interventions and, in recent years,well-publicised instances of poor practice that haveplaced concerns about patient safety at the centre ofthe policy agenda. In the UK, the cases of Peter Green,a general practitioner (GP) who sexually abused hispatients, and serial killer Harold Shipman are recentexamples in primary care of the lack of both colleagueand external constraints on individual practice.5 Atthe same time, information-based technologies, intheory at least, provide opportunities for the externalsurveillance of clinical medicine through data collectionand evaluation. Nevertheless, regulating primarycare presents particular difficulties. General medicalpractices tend to operate as small businesses on a smallscale. A wide range of other health and social careprofessionalsmay also operatewithin practices or withinparallel structures. In addition, managerial authorityand capacity within, and over, practices is highlyvariable. These factors play out differently within thestructure of each health system.This issue of Quality in Primary Care looks at somerecent changes in how professional work is regulated –particularly in relation to the selection of healthcareregulators, primary care mental health workers andpatient safety. To set these contributions in context,we consider how regulation is currently defined and itsscope within the UK.</p>