PubMed · 2006583
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K I Marton. 1991. Modifying physician practice patterns--reflections on past deeds.. https://pubmed.ncbi.nlm.nih.gov/2006583/
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One of the aims of the Tomlinson report is to shift more care from the secondary to the primary sector in London. But the primary sector is already underresourced and overloaded. The capital has a heterogeneous population which often makes inappropriate demands on general practitioners. Many premises are inadequate and there are insufficient support staff. David Metcalfe emphasises that London is special and that the shift will not become a reality unless these problems are tackled. He suggests the establishment of different models of practice centres which could treat some of the patients who now go to accident and emergency departments. Some would be the night emergency service base, some would have primary care beds, and each would have a different mix of specialist support.
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Medical audit has been defined as "a systematic critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome for the patient". In Britain, recent reforms of the Health Service increase the need for neurologists to undertake audit. The basic principles of audit in relation to the management of common conditions such as headache and epilepsy are described. Audit must consider not only efficiency but also effectiveness, but the difficulty of developing valid outcome measures should not be underestimated, especially in chronic disabling conditions.