Quality in Primary Care Open Access

Introduction

The information needs and challenges facing primary care are unique, reflecting the range of patient needs encountered and the organisational structures in-volved. Practices and other primary care centres are bound together in organisational terms by member-ship of primary care trusts (PCTs) but still face the challenges of being geographically disparate. At the same time PCTs are relatively new organisations that are still undergoing the process of embedding them-selves fully within the primary healthcare culture. The resources featured below are, in the main, concerned with the management issues facing PCTs and asso-ciated primary care organisations. As with all these Knowledgeshare articles, this listing is not compre-hensive but aims instead to give a taste of what is available to support those working in primary care.

Centre for Innovation in Primary Care (CIPC): www.innovate.org.uk

The She¤eld-based CIPC looks to o¡er healthcare professionals and managers in PCTs the opportunity to develop e¡ective solutions to the challenges facing them. Building from an original base of material developed through city-wide work undertaken in and around She¤eld, CIPC now works with other primary care providers around the country to pro-mote the dissemination of e¡ective practice across primary care networks. Much of the content of the site is given over to the various areas where CIPC can be of assistance to others within a consultative role. It should be noted that CIPC is a not-for-profit organ-isation, partially funded by the NHS, and that charges associated with the services cover costs only.

The site also features links to a number of other sites concerned with primary care and hosts a number of documents, developed by CIPC, concerned with common problems faced in the primary care setting.

Visitors to the site may register and this allows users to up-load information about their innovations to share them with other users of the site.

Stylistically the site is somewhat weak, particularly for new users, as the index page does not di¡erentiate major sources of information from single documents and links out to other sites. There is no direct link to information about the organisation from the index page and the choice of colours for this page do not appear to be conducive to use by individuals with visual impairments. The site does have a simple-to-use menu for navigation on all pages except the index page.

Users should not be deterred by the poor design of some elements of this site. CIPC are generous with the documents they share and persevering through the navigational di¤culties could pay dividends for users concerned with areas already covered by CIPC.

Department of Health Primary Care: www.doh.gov.uk/pricare/index.htm

As anyone who has more than glanced at the Depart-ment of Health (DoH) website will testify that the DoH publish a huge range of documentation; indeed many new visitors feel that the range is so great as to be bewildering. The plethora of services and policies that the DoH has to cater to perhaps makes this inevitable, however, the grouping of similarly themed documents makes finding appropriate information considerably easier for the user.

This primary care section of the DoH website brings together documents from across a range of policy foci. The top of the page o¡ers users a range of options to access other sections of the site not specifically linked to primary care but pertinent to its operation. Further down the page is split into headed sections, marked with bullet points, with other relevant documents listed beneath each heading where appropriate. This does not always represent the full range of documents available within a particular category. For instance, the Primary Care Trusts head-ing has six key documents listed under it but if a user actual follows the link attached to the heading an entire new section opens up featuring dozens of documents of import to the management and run-ning of PCTs.

There is probably little value in being overly critical of the DoH website design. Any website required to host as many documents as the DoH would almost certainly find itself running into the problem of having overly filled pages, as the current site does, or of having so many better-designed pages that users would constantly get lost. It is possible to argue that the DoH website actually su¡ers from both these problems but it is di¤cult to imagine how it could be overcome. The major problem that should be addressed is the functioning of the search engine. To avoid overwhelming returns, use the advanced search option and always indicate that search results must contain all the terms entered.

The DoH primary care site is an invaluable tool, especially for those involved in the management of primary care services. If users can find the time to familiarise themselves with this section of the DoH site it can be a highly e¡ective in meeting policy-related and other information needs.

PRIMIS (Primary Care Information Services): www.primis.nhs.uk/pages/default.asp

PRIMIS is a service based within the University of Nottingham that operates as part of the NHS Infor-mation Authority. The purpose of the organisation is to promote the e¡ective gathering and use of data within GP practices across England. This is achieved through a range of services and training opportunities that are made available through PRIMIS facilitators employed within local PCTs and other relevant trusts. At the time of writing there were 309 facilitators working in 248 PCTs. The website outlines the requirements for trusts wishing to participate in the PRIMIS system and employ a facilitator. It also gives clear indications of the range of data quality services and training opportunities that are available and how these are facilitated.

The PRIMIS site is not large and all the documents contained within it are clearly focused. The advantage of a limited information range in website design can be seen here as the various pages are easy to read and clearly laid out. Every page has the same navigation bar on the left side allowing users to navigate around the site easily. The only real criticism of the site is that the map page that gives access to the details of PRIMIS facilitators is slow to load and cumbersome to use. A simple clear alphabetised list would have been a more e¡ective tool.

Overall the PRIMIS site is well designed and makes an excellent job of matching its content to its purpose. For users concerned with addressing data quality and electronic records issues this is an excellent site to visit when considering the way forward.

National Primary Care Research and Development Centre (NPCRDC): www.npcrdc.man.ac.uk/

NPCRDC is a research centre based at the University of Manchester. The home page of the site gives users the opportunity to find out more about the centre, its work and publications. There is a searchable database of NPCRDC publications and a forum, requiring the completion of a free registration process for com-plete access, that allows users to share news ideas and practices.

The site also links out to two other major resources and it is these that makes the site noteworthy. The first of these is a database of primary care datasets that can be used by any NHS member of sta¡ or academic researcher. Access to the database requires the com-pletion of a free but lengthy registration form that has to be returned by standard post, not email. However, the range of data available for use by registered users suggests that it might be worth the e¡ort. Datasets within the database include among others:

•Population Types

•ONS Census

•Measures of Deprivation

•Practice Need Measure

•PPA Prescribing Measure.

The second resource of interest is a pre-assessed patient quality questionnaire called GPAQ that focuses on areas of patient satisfaction not covered by the national Quality and Outcomes Framework, such as continuity of care and access to care. The questionnaire, a handbook on how to administer it, key frameworks for analysing the questionnaire out-comes, and software for more advanced analysis of results are all freely available for download.

The NPCRDC home page and associated site is reasonably well designed, although it is crowded in places and access to the publications database is not that intuitive. The dataset site, which opens in a separate window, is positively complex with a baing array of information and links available and no clear guidance as to what information is held where for the less experienced user. There is also a problem with the map interface for the database that allows users to access certain types of geographically defined data. Most users will have to download a piece of software to make the map work, however, it is an executable file which most trusts will not allow directly onto their IT systems for fear of virus contamination. Unfortu-nately, there are some datasets that can only be accessed via the map so users may find themselves unable to use the full range of services from the dataset database.

There are navigation problems with the dataset database and some minor design flaws in the home page site but this is still a site that gives users access to a wealth of data that could be of great use to re-searchers and planners in primary care services.

Primary Care (Modernisation Agency): www.primarycare.nhs.uk/

This site is one of a number operated by the NHS Modernisation Agency. Its purpose is to support the development of PCTs at a management and board level. The site seeks to link the national requirements for the operation of PCTs into recognisable areas to which members of these organisations can relate. There are three key headings within the site:

1 Improving services

2 Developing people

3 Building organisations.

The site itself acts more as a gateway, giving users an overview of critical areas but mainly directing them to the correct organisation or individual to gain the support that the user deems necessary.

As with the PRIMIS site above the Modernisation Agency’s website is relatively small and has a clearly focused agenda. The individual pages and the sections therein are clearly laid out with a minimum of clutter. Navigation within the site is easy and intuitive so the less experienced user should find this site easy to operate.

This site does not set out to answer all the questions that might arise surrounding the successful operation of a PCT. It is very successful, however, in directing the user to most appropriate resources in a simple manner. An excellent site for users concerned with the operation of PCTs.

The National Primary Care Development Team (NPCDT): www.npdt.org/scripts/default.asp?siteid=1

This NPCDT website is concerned with delivering resources to primary care organisations to assist with lasting quality improvements in patient care and access throughout primary care. NPCDT have devel-oped a number of programmes and strategic manage-ment tools that address these issues. The site features resources for implementing the collaborative meth-odologies, developing advanced access appointment booking systems, leadership for quality improvement, SMART care programmes and the Falls Collaborative. Some resources to do with these programmes and resources to do with the operation of NPCDT are available directly from the site. However, many of the programme materials require a user name and pass-word to gain access and this can only be obtained from NPCDT after a user registers his or her interest in a particular programme.

The site design is reasonably intuitive in use with a standard menu available on every page within the site. The layout is uncluttered and links between the pages are clear. The only criticism of the design of the page is that the items on the navigation bar menu are too small and this could result in users accidentally accessing the wrong page.

This site is a good resource for those interested in the application of management theories to quality improvement issues within primary care. It is not possible to judge the overall quality of the full programme resources as access is password con-trolled, but if the items included on this site are an indication of the overall general quality then they should prove very useful to interested users.

Practice Nursing Community: www.practicenursing.co.uk/

There is a major challenge in setting up an online or virtual community: that of participation. A website serving a virtual community of interest, such as a particular profession as in this case, can be excellently designed and well maintained but simply not used. Fortunately this is not the case with this site. Many healthcare sites o¡er a range of information resources and then tag on a forum for user discussion almost as an afterthought, or at least that is how it appears from their design. This site is built around a core forum which allows practice nurses to share ideas and address common questions and issues. In addition to the core forum, the site features job adverts, job requests and an extensive links section. The forum might be a little confusing for those unaccustomed to following discussion threads on such sites but a little application will soon help the novice user understand how the site operates. Full access to the forum requires the completion of a free registration process.

Each section of the site is clearly marked out but some of the sections, for instance the links area, are a little crowded. There is an easily understood menu on each page that makes navigation easy and the site overall is very friendly to use.

This site is an excellent forum for practice nurses, who are often isolated from others in similar profes-sional positions, to cultivate the spread of best practice and the exchange of knowledge.

Conclusion

The nature of primary care lends itself to the devel-opment of electronic solutions to address issues of information supply and sharing. This has led to a situation where there are more web resources for primary care information than are ever likely to be used by professionals within the field. Only time will tell which of these resources are used and which fall by the wayside. The resources selected above seem likely to prevail based upon the strength of their user community, the prominence of the site developers, or both of these factors. Hopefully these will lead the reader to further explore the range of resources available within primary care and thereby make informed decisions about the sites he or she chooses to use.