title: General practitioners' views on quality markers for children in UK primary care: a qualitative study.
abstract: BACKGROUND
  Children make up about 20% of the UK population and caring for them is an important part of a general practitioner's (GP's) workload. However, the UK Quality Outcomes Framework (pay-for-performance system) largely ignores children - less than 3% of the quality markers relate to them. As no previous research has investigated whether GPs would support or oppose the introduction of child-specific quality markers, we sought their views on this important question.
  
  
  METHODS
  Qualitative interview study with 20 GPs from four primary care trusts in Thames Valley, England. Semi-structured interviews explored GPs' viewpoints on quality markers and childhood conditions that could be developed into markers in general practice. Interviews were audiotaped and transcribed verbatim. Analysis was thematic and used constant comparative method to look for anticipated and emergent themes as the analysis progressed.
  
  
  RESULTS
  All the GPs interviewed supported the development of 'benchmarks' or 'standards' to measure and improve quality of care for children. However no consensus was expressed about the clinical conditions for which quality markers should be developed. Many participants reflected on their concerns about unmet health care needs and felt there may be opportunities to improve proactive care in 'at risk' groups. Some expressed feelings of powerlessness that important child-relevant outcomes such as emergency department visits and emergency admissions were out of their control and more directly related to public health, school and parents/carers. The importance of access was a recurrent theme; access to urgent general practice appointments for children and GP access to specialists when needed.
  
  
  CONCLUSIONS
  The GPs expressed support for the development of quality markers for the care of children in UK general practice. However, they flagged up a number of important challenges which need to be addressed if markers are to be developed that are measureable, targeted and within the direct control of primary care. Easy access to primary and secondary care appointments may be an important benchmark for commissioners of care.
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, UK. peter.gill@phc.ox.ac.uk
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Gill
authors.forename: Jenny
authors.initials: J
authors.lastname: Hislop
authors.forename: David
authors.initials: D
authors.lastname: Mant
authors.forename: Anthony
authors.initials: A
authors.lastname: Harnden
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019985:Benchmarking; D002648:Child; D002662:Child Health Services; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D036301:Qualitative Research; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive; D006113:United Kingdom