A systematic review of international performance indicators and metrics relevant to UK general practice

Background: A wide variety of performance indicators/metrics are used to measure the performance of healthcare systems and to promote quality improvement (QI). We sought to identify indicators relevant to QI and organisational development (OD) within primary care/general practices and to evaluate the evidence for their use in QI and OD interventions in UK general practice and primary care. Methods: We used a framework based on UK NHS primary care documents to structure the review. Separate literature searches were performed in four databases to identify relevant reviews and primary studies. Studies were included if (1) the main focus was a metric or indicator that fell within the review framework or (2) they reported an OD or QI initiative or intervention in UK primary care that used one or more of the previously identified metrics or indicators. We mapped studies in group (1) against our framework domains. We performed a narrative synthesis of studies in group (2), again organised by the overall framework. Results: We included 28 studies, 24 (11 reviews and 13 international primary studies) for metrics or indicators and 4 for initiatives or interventions. The number of individual indicators or groups of indicators in group (1) studies ranged from 1 to 773. Three of the four UK QI/OD studies focused on initial access to general practice services; the other dealt with a programme to encourage self-care for long-term conditions. Mapping of the group (1) studies identified potentially relevant indicators across all domains but the process was methodologically challenging. Conclusions: Although numerous potential indicators exist they tend to be poorly defined and lack examples of their use in practice. Further work is needed to identify and evaluate candidate indicators.