Approaches to high quality best practice care in the seven GP Super Clinics were evident. Most of these related to quality improvement approaches such as collaboratives or quality assessment approaches such as through accreditation. Patient satisfaction surveys and data collection in the context of specific collaboratives had also been undertaken.
All of the GP Super Clinics had participated or were about to participate in accreditation processes. A number of GP Super Clinics cited participation in a number of accreditation processes beyond systems such as Australian General Practice Accreditation Limited (AGPAL). Training practices are accredited according to Royal Australian College of General Practitioners (RACGP), and the Australian College of Rural and Remote Medicine (ACRRM) standards, depending on location and range of experiences available for GP Registrars.
All GP Super Clinics had developed or adapted clinical policy and protocols for some conditions with reliance on RACGP guidelines. These guidelines may be clinically appropriate for general practitioners but do not always reflect the multi-disciplinary care model applied by the GP Super Clinics.
Some of the GP Super Clinics have participated in the national Primary Care Collaboratives. Two GP Super Clinics reported participation in the Closing the Gap - Improving Indigenous Access to Mainstream Primary Care Program. Another GP Super Clinic had participated in a Diabetes Primary Care Collaborative. Other local initiatives evident in most GP Super Clinics were clinical meetings and clinical review meetings.
Aligned with evidence, approaches to quality in general practice tend to be project-based.34 There was limited evidence of the extent to which these were embedded as part of the culture of the workforce in the GP Super Clinics. Delivering high-quality care in a multi-disciplinary environment requires new models of shared care to be developed in collaboration with a range of disciplines within and external to the GP Super Clinics. It was common for GP Super Clinics to adopt but not tailor RACGP clinical guidelines to their settings regardless of the context in which they provided services. Given that these do not necessarily reflect the evidence of multiple disciplines, their relevance could be questioned and ownership, and hence compliance by disciplines, reduced
Barriers to embedding approaches to quality identified through interviews with clinicians were numerous. First, in this early stage of maturation, the priorities of the GP Super Clinics were on other issues. This is not to say there was not a commitment to quality, with numerous examples provided. However, it was evident that other organisational priorities had been addressed. Second and related to the first barrier of relative priorities, is that embedding quality as part of the culture requires leadership, which at this stage had been directed towards other priorities in the GP Super Clinics. Third, it was evident that the knowledge of and skills in approaches to embedding quality was at best variable. Last, as identified in the evidence, in the absence of a systematic approach to quality across the primary care sector, approaches to quality which measure and allow comparison of performance are not possible.
34Improving the Quality of Care in General Practice: Report of an independent inquiry commissioned by The King’s Fund. London: The King's Fund;2011.