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General practice accreditation in Australia: Data from 2010–2021
During the 10-year period 2010–2019, both the number and proportion of accredited general practices increased in every state and territory and the number of FTE GPs increased. In 2020, more practices were accredited in a single year than in any year in the preceding decade. In 2021, the number of accredited general practices was lower than its preceding year for the first time since 2011.
Most Australian general practices now routinely participate in accreditation and have a choice of independent accreditation agencies. Consequently, the care delivered by accredited Australian general practices has arguably never been safer.
It is encouraging that more than 80% of practices are accredited in all except one of the states and territories. The gap between accredited and unaccredited practices reduced in all states and territories between 2010 and 2019. Further investigation regarding the remaining gap is needed. Why do proportions of practices in the states and territories remain unaccredited? What resources and professional support do practices need to pursue and/or attain accreditation? In 2019, accreditation in the Northern Territory remained an outlier among the states and territories, despite the territory’s sizeable increase in accreditation over the study period. The data available do not show why this is the case, so particular attention and consultation are needed concerning accreditation in the Northern Territory.
In the last decade, there was limited choice for practices of accreditation agencies, with AGPAL and QPA the only agencies available. There are now five agencies available: AGPAL, QPA, the Australian Council on Healthcare Standards, Global-Mark, and the Institute for Healthy Communities Australia Certification. Additional agencies will impact the general practice accreditation market over the next decade. There is potential for even more agencies to join the market. Over the study period, QPA demonstrated a capacity to steadily grow its market share. No data are yet available to analyse the effect new agencies will have on market share. In several years’ time the accreditation market share may be more widely distributed among more agencies. Further research is needed around factors that influence practice choice when selecting an accreditation agency.
While the RoGS data provide no context as to why accreditation figures may rise or fall, we can hypothesise various reasons for the increase in general practice accreditation up to 2020 and its slight decrease in 2021. For instance, more practices might have sought financial support through PIP, which can only be accessed when the practice is accredited. Or, increased accreditation could signal an increase in positive safety cultures in general practice. Most recently, the effects of the COVID-19 pandemic on practices’ capacity to participate in accreditation and surveyors’ access to practices during periods of border closures and lockdowns may have impacted the number of accredited practices. More data and research are needed to test these hypotheses.
Changes to editions of the Standards may have contributed to the increase in accreditation. However, as we cannot determine the proportion of accredited practices immediately before the release of the fifth edition (2017) it is not possible to make a comparison with the figures after its release.
The RoGS provides data over several points in time, giving evidence of general practice accreditation trends in Australia. Some of this is not available elsewhere (including the number of accredited practices annually), so the RoGS is an important resource to demonstrate the current and historical state of accreditation. Having these data allows us to make inferences about the next steps and make recommendations about how to further improve care quality and accreditation.
However, the RoGS data do not provide evidence whether accreditation is associated with improved clinical outcomes or quality of care. The RoGS data are presented without variational context (eg detail on why there are differences between regions). The RoGS data do not show which edition of the Standards general practices are accredited against (in years where there is an overlap of two editions), or whether certain events account for changes to accreditation rates. Because of these limitations, various hypotheses cannot be validated to gain more insight into the reasons why accreditation increased considerably across all states and territories during the study period. The RoGS also provides no data on the total numbers of general practices between 2012–2017 and 2020–2021, so we do not know whether any change in general practice accreditation was steady or fluctuating over the 10-year period from 2010–2019, or whether the proportional increase has continued in the past two years. Further, the RoGS data have not reported on accreditation activity by the new accreditation agencies.
The RACGP, ACSQHC and accreditation agencies all have a part to play in improving accreditation for general practice. Including more variables in the data would help to examine areas of particular interest, such as geographic distribution, practice size or whether a practice is newly accredited. To understand accreditation, we may therefore need to consider multiple sources of data.
Data-driven improvement monitors progress toward objectives and is a well-established principle for quality improvement.8 The RoGS data do not inform us of compliance to accreditation indicators in the Standards, or variation between practices and agencies. Analysis of practice compliance data – provided by the accreditation agencies – can provide us this information. Each of these stakeholders can use accreditation compliance data to reveal aspects of accreditation and the Standards that practices find straightforward, or difficult to meet. Such analysis can lead to the implementation of improvements to the Standards, or the way a practice understands, interprets and enacts aspects of the Standards and accreditation. Work is underway to assess compliance data and its possible insights.
Over the next decade, a large challenge will be converting data (including accreditation and compliance data) from multiple sources consistently, reliably and accurately into useful information and knowledge. We need a data-driven approach to ensure productive primary care.
Future RoGS can be used as one measure to analyse if improvements made because of access to compliance data affect participation in accreditation (eg over time, seeing if accreditation increases in states and territories in years following targeted efforts to improve compliance).
Further accreditation research and stakeholder consultation is needed to explain many of the observations found in accreditation data (be it RoGS or subsequent analysis of accreditation compliance data), including:
In the next 10 years, we must develop more efficient methods of accreditation that address barriers to continuous quality improvement, and the impact that the current accreditation system (advanced notice and face-to-face assessment) has on practices that want to be accredited. We need to explore accreditation’s impacts on practice time and cost, and whether new methods can make accreditation more viable and attractive to practices. Research undertaken into accreditation methods needs to assess the acceptability, feasibility and usability of the available and proposed processes.
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