Improving quality of care through general practice accreditation
Submitting InstitutionUniversity of Manchester
Unit of AssessmentPublic Health, Health Services and Primary Care
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Summary of the impact
Research conducted at the University of Manchester (UoM) has shaped the
design of national systems of accreditation for general practice in the
UK, Europe and beyond. Accreditation systems set standards that reflect
key aspects of the organisational systems and processes in general
practice that are needed to ensure delivery of good quality care.
Accreditation systems also provide a kite mark of quality assurance and
act as a platform for supporting continuous quality improvement. UoM
developed indicators of quality in general practice structure and
organisation and demonstrated how they could be used effectively to
improve quality. Working in partnership with health professional
organisations, governmental organisations and other universities, UoM used
knowledge from the research to develop systems for general practice
accreditation now used in the UK and across Europe.
See numbered references in section 3.
The impact is based on research that took place at UoM from 1995 to date,
with the first major publication in 1998. The key researchers were:
Stephen Campbell (Professor of Primary Care Research,
Helen Lester (Professor of Primary Care, 2006-2011)
Martin Marshall (Professor of General Practice, 2000-2006)
Martin Roland (Professor of General Practice, 1992-2009)
The work was conducted by the National Primary Care Research and
Development Centre (NPCRDC), a Department of Health funded policy research
unit based in UoM. The programme of research initiated in 1995 (i)
developed measures of quality of care in general practice, (ii) described
and explained variations in quality and (iii) developed and tested
interventions to improve the quality of care. The programme is underpinned
by a conceptual definition of quality of care which showed that quality
measurement must address clinical excellence (e.g. adherence to clinical
care standards) as well as patient experience, underpinned by sound
organisational systems and processes for driving quality improvement (1).
This case study describes the impact of research relating to measures of
organisational quality. Separate case studies in this UoA describe the
impact of research relating to measures of patient experience and clinical
Governments need to have accreditation systems in place to ensure that
healthcare provider organisations meet desired standards of care quality
and safety. This requires the development of care quality standards and
measures that can be applied efficiently to assess whether an organisation
has the necessary organisational systems and processes in place to deliver
safe and effective care. NPCRDC developed innovative methods to design and
test indicators of quality in the organisational systems and processes
within general practice that underpin care quality and safety (2).
In collaboration with the Universities of Nijmegen and Heidelberg, NPCRDC
applied these methods to the development of a European Practice Assessment
accreditation scheme suitable for use by general practices across Europe
(3,4). The research was funded by the Bertelsmann Foundation. The European
Practice Assessment accreditation scheme won the 2009 award of the
European Health Forum Gastein. This award, widely regarded as the
'European Oscar' for healthcare, is given for major innovations in
European healthcare. Subsequent research demonstrated the effectiveness of
practice accreditation as a method for driving quality improvement in
primary care (5).
In the UK, NPCRDC worked in partnership with the Royal College of General
Practitioners (RCGP), applying knowledge from the research to the
development of a British system of Practice Accreditation (6). The
development work was undertaken in close collaboration with the General
Medical Council, Royal College of Nursing, Care Quality Commission,
Department of Health, NHS Confederation Primary Care Trusts and patient
groups to ensure the Practice Accreditation scheme was aligned to the
priorities and concerns of other key stakeholders.
References to the research
The research was published in high impact health services journals,
including: Social Science and Medicine, the British Medical Journal and
the British Journal of General Practice and is highly cited.
1. Campbell SM, Roland MO, Buetow SA. Defining quality of care. Social
Science & Medicine 2000;51(11):1611-25. DOI:
2. Campbell SM, Braspenning J, Hutchinson A, Marshall MN.
Research methods used in developing and applying quality indicators in
primary care. BMJ. 2003;326(7393):816-9. DOI: 10.1136/bmj.326.7393.816 / Campbell
SM, Braspenning J, Hutchinson A, Marshall M. Research
methods used in developing and applying quality indicators in primary
care. Qual Saf Health Care. 2002;11(4):358-64. DOI: 10.1136/qhc.11.4.358
4. Engels Y, Campbell S, Dautzenberg M, van den Hombergh P,
Brinkmann H, Szecsenyi J, et al. Developing a framework of, and quality
indicators for, general practice management in Europe. Family Practice.
2005;22(2):215-22. DOI: 10.1093/fampra/cmi002
5. Goetz K, Campbell SM, Steinhaeuser J et al Does a
quality management system improve quality in primary care practices?
Canadian Medical Association Journal 2011.
6. Campbell SM, Chauhan U, Lester H. Primary Medical Care
Provider Accreditation (PMCPA): pilot evaluation. British Journal of
General Practice. 2010;60(576):295-304. DOI: 10.3399/bjgp10X514800
Details of the impact
See numbered corroborating sources (S) in section 5.
The European Practice Assessment (EPA) scheme has been used by 1,584
practices (1,170 primary care practices) across 7 countries: Germany,
Switzerland, Austria, Belgium, Greece, Romania, Slovenia. The scheme and
the indicators are available in the following languages: English, Dutch,
French, German, Romanian, Slovenian, Greek, Arab and Hebrew. Overall, 507
practices have used the EPA scheme (S1).
In 2005 the German federal government introduced a regulation which
stipulated that all healthcare providers, including general practices, are
obliged to implement an annual quality management programme in order to
demonstrate compliance with national systems for accountability in
healthcare provision. The European Practice Accreditation scheme, designed
by NPCRDC with its European partners is one federally approved option for
demonstrating compliance in general practice (S2). Implementation was
supported by our partners in the University of Heidelberg and the
Institute for Applied Quality Improvement and Research in Health Care
(AQUA-Institute) in Gottingen. In total 303 primary care practices have
used EPA in Germany. 103 of these German general practices used the
European Practice Accreditation scheme twice, to measure longitudinal
changes in quality improvement over the period 2008-date (S2). Practices
showed an overall 10% increase in scores across the domain "Quality &
safety" including "complaint management" (30% increase), "critical
incident analysis" (10%) and "quality procedures and policies" (15%).
The methods used to develop the European Practice Assessment for general
practice have been applied by the AQUA-Institute to develop a European
Practice Assessment scheme for dental healthcare provision in Germany
(S3,S4). From 2008, 187 dental healthcare organisations have used the
EPA-Dental scheme to assess their quality of care (63 having used it
twice). Compared with the comparative group at first assessment, the
intervention group at second assessment had significantly better scores
for the domains "infrastructure" (Intervention group 94.2%, Comparative
group 84.0%) and "quality and safety" (Intervention group 88.7%,
Comparative group 78.1%).
In the UK, the General Practice Accreditation scheme developed by the
Royal College of General Practitioners in partnership with NPCRDC was
implemented in July 2011 and closed to new applicants in February 2013
(S5,S6). Upon successful completion, Practice Accreditation is valid for
three years. From 2011, 260 of the 8,088 general practices in England have
sought accreditation of which 4 have been successful with the remainder
ongoing. The scheme consists of six domains with the 78 standards, 42 of
which are mapped to processes, protocols and systems that specifically
support the requirements of CQC registration. The fulfilment of the RCGP
Practice Accreditation scheme will enable practices to demonstrate
compliance with the registration requirements of the Care Quality
Commission (CQC) which, from April 2013, is responsible for quality of
assurance of English primary care.
The Irish College of General Practitioners have built on the EPA and RCGP
accreditation schemes to develop their own national scheme, and informed
European-wide discussions on accreditation as led by EQUIP-WONCA (S7).
Sources to corroborate the impact
S2. Letter from AQUA Institute in Göttingen (J Szecenyi) which used a
modified version of the indicator development process as part of the
Federal Government work.
S3. Götz K, Szecsenyi J, Broge B, Willms S. Welche Wirkung hat
Qualitätsmanagement in Arztpraxen? Ergebnisse aus Entwicklung und
Evaluation des Europäischen Praxisassessments (EPA). Aqua-Verlag,
S4. Qualitätsmanagement-Systeme für die Zahnarztpraxis.
Informationsdienst des Instituts der Deutschen Zahnärzte (IDZ), Köln, 2005
S6. Letter from RCGP detailing recruitment to practice accreditation
http://www.topaseurope.eu/?q=node/3 for WONCA-EQUIP which notes role