Author's response

[摘要] We accept the rebuke of Howie et al for not acknowledging their work on devising the National Health Service Practice Performance Index at practice level. Although I have heard Professor Howie expound eloquently the concept of the Consultation Quality Index (CQI), we considered this to be an organic internally derived professional exercise rather than an externally imposed assessment. Our object was not to set up a new performance framework as such, but to see if we could improve the acceptability of what appeared to be an arbitrary collection of government parameters. It was this very arbitrary nature that we felt could be alienating the profession rather than necessarily the concept of being subjected to performance review, which is where Dr Ambury is taking us to task. Since writing the study of course things have moved on and we now have a new GMS Contract with a further raft of quality and outcome measures, which will no doubt inform and stimulate this debate.

[学科分类] 卫生学