Introduction

Section I has highlighted the issues which need to be considered by those developing any performance management programme. GP practices are the focal point for a range of services encompassing a large number of specialties (e.g. nursing, chiropody, physiotherapy, minor surgery, mental health, counselling, social work). The relationships between individual providers of care (medical or otherwise), the structures and organisations in which they work, and the quality and outcomes of patient care they provide are interrelated and are all important in the quality debate (Donabedian 1980; Gray 1992; Hutchinson 1997). Owing to the diverse nature of the services on offer, the different groups involved in the delivery of care and the complex nature of health and illness behaviour within the population it has often been suggested that quality cannot be assessed (Baker 1992). However, if quality is approached in a systematic manner, with consideration given to the range of issues outlined, then assessing performance and improving the quality of NHS care is possible.