Editor's blog Monday 11 October 2010: Defining quality for general practice in the post-White Paper NHS

The management thinker Russell Ackoff famously wrote, "'quality' is a term so vague as to be practically meaningless. Use it as often as you can!".

In Nick Goodwin's latest blog for the Kings Fund, he explores what quality improvement means - and should mean - in general practice. It is based on this new discussion paper for the Kings Fund inquiry into the quality of general practice, which is itself an excellent and thought-provoking document.

Nick suggests that a future NHS that was serious about quality improvement in general practice would include "support systems that help GPs to make evidence-based decisions in clinical real time; transparent sharing of data about performance with patients, the public and peers; accountability for performance among peers combined with the judicious use of financial incentives; regular sharing of ideas and experience between practices and investment in education and training; and for the minority of practices that perform poorly, governance arrangements for effective and timely remedial action".

All of these ideas sound good. The first of them would be possible if NHS broadband were blazingly fast (which it isn't).

The obvious challenge with Nick's second and third ideas - data sharing and transparency and idea and experience-sharing - is that the new world looks like a place of competition and choice. And if I have a competitive advantage over my peers, and must rely on competing for patients, commissioners and even providers to choose my services, I have a good incentive not to share.

And if I am no longer performing the activities of a statutory NHS body  - and most particularly if I am a commercial organisation (even if not-for-profit, to access the state-backed NHS pension scheme) who gets their work from a mixture of public and private sources, then you can send me Freedom Of Information requests until you are blue in the face - and I will not have to answer them.

And if the law is then altered to tell me that I must, then I will have a qualified exemption.

Nick's final idea, of sanctions against poor performers, butts up against the issue of who would do this performance management in the new system. The Care Quality Commission's job is  to notice bad performance, and this may even happen, once they register all practices by 2011-12. Revalidation is sitting comfortably in the long grass. The "light" National Commissioning Board will hold the contract with a practice. And badly-performing GPs might start to gather letters of support from the commnunities they serve. There could be plenty of wriggle-room amid all that.