Performance indicators for primary care groups: an evidence based approach

In England primary care groups will have a key role in promoting the health and improving the health care of their local population.1 By April 1999 these groups, involving all primary care professionals, will provide and commission health care for roughly 100 000 people in each locality. Primary care groups will be accountable to health authorities and “will agree targets for improving health, health services and value for money.”1There will be several primary care groups in each district health authority. This new approach offers primary care the opportunity to further integrate health promotion and health care at the individual and population levels. The present UK government intends to manage the performance of the “new NHS”; the word performance appeared 88 times in its recent white paper.1 It has published a national framework for assessing performance as a consultation document,2and primary care groups within health authorities will be judged to have “performed” well on the basis of the indicators listed in table 1. Most are attributable in part to primary care, but only some are linked to interventions that will necessarily lead to improved health outcomes. The government has also proposed four targets for England in its green paper Our Healthier Nation.3 Approaches taken by health authorities, and presumably by primary care groups, will be “fully monitored by the Regional Offices of the NHS Executive.”3 These targets for reduced death rates from heart disease and stroke, cancer, suicide, and accidents are all outcome indicators but, again, are only partly attributable to primary care.