Abstract

In the current climate of advances in medical knowledge,
changes in the pattern of illness and pressures of
demand, many countries are seeking to strengthen
their primary care services to improve quality. These
first-line services provided by a range of professionals
within local communities are seen as being best placed
to prevent, or intervene early in, the illness process
in ways that are cost-effective.The challenge to
governments lies not only in channelling resources
into primary care, but also in ensuring that these are
used to raise standards of care internationally. One
consequence has been a rise in the regulation of clinical
work, an area where in the past professionals have
exercised considerable autonomy and been relatively
free from external scrutiny.The case for increased regulation is a consequence not only of governments’ desire to curb healthcare spending, but also of such factors as research on unexplained variations in practice, the growth of more evidence-based interventions and, in recent years,
well-publicised instances of poor practice that have
placed concerns about patient safety at the centre of
the policy agenda. In the UK, the cases of Peter Green,
a general practitioner (GP) who sexually abused his
patients, and serial killer Harold Shipman are recent
examples in primary care of the lack of both colleague
and external constraints on individual practice.5 At
the same time, information-based technologies, in
theory at least, provide opportunities for the external
surveillance of clinical medicine through data collection
and evaluation. Nevertheless, regulating primary
care presents particular difficulties. General medical
practices tend to operate as small businesses on a small
scale. A wide range of other health and social care
professionalsmay also operatewithin practices or within
parallel structures. In addition, managerial authority
and capacity within, and over, practices is highly
variable. These factors play out differently within the
structure of each health system.
This issue of Quality in Primary Care looks at some
recent changes in how professional work is regulated –
particularly in relation to the selection of healthcare
regulators, primary care mental health workers and
patient safety. To set these contributions in context,
we consider how regulation is currently defined and its
scope within the UK.