ABSTRACT

Public knowledge about health matters has increased and expectations about what the national health service (NHS) can and should provide have risen. A number of co-terminous 'external' socio-demographic and economic factors and 'internal' service-orientated developments have resulted in the NHS coming under increasing pressure. In response to calls for greater efficiency and improved effectiveness in the NHS, a range of service re-organisations has taken place. The primary care – that is care predominantly provided by general practice, community nursing and psychiatric services, and the professions allied to medicine – has witnessed substantial changes to the ways in which services are organised, managed and delivered. The Labour government has sought to place quality firmly at the heart of healthcare policy and practice. At a national level, legislation has been passed concerning standards of General Practice performance and several polices have been introduced which specifically relate to the performance management and quality assessment processes within the whole of the NHS.