Blakeway-Phillips, Clare Deborah
(1995)
Organisational standards and a monitoring process for general practices/health centres in the UK.
MPhil thesis, London School of Economics and Political Science.
Abstract
This thesis is based on a research project to test the feasibility of developing organisational standards and a means of assessing compliance with these standards for general practices/health centres to ensure robust systems and structures for quality service delivery are in place. Nine pilot sites, involving twelve practices, participated. A detailed account of the research project is given from the researcher's perspective as an involved observer. An 'accreditation' type approach has never previously been introduced to primary health care teams. The background to this experiment is first discussed:- quality of health care as a public policy issue; the rise of primary health care on the health agenda, the shift from secondary to primary care and whether primary health care teams can bear this extra burden of expanded responsibilities. General practices are the least formal organisations within the NHS, relying on a system of organisation that has changed little since the NHS was established in 1948. However, practices are now structuring themselves into more formal organisations. The potential relevance of organisational audit in helping practices become formal organisations capable of delivering high quality primary health care is advanced. The origins and rationale for organisational audit in primary health care are explored incorporating a review of the literature on accreditation. There follows a description of the project. It begins with a chronological account of the development and implementation of the organisational standards and criteria by the pilot sites and how their compliance with the criteria was assessed. Problems that arose and how they were surmounted are highlighted. Changes that took place in the organisation of the pilot sites while the project was occurring are described followed by a reflection of the validity of the whole exercise and implications for future policy.
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