Using referral letters to measure quality and performance in general practice.

Although quality assurance is a concern of professional Colleges of General Practice and researchers in primary care, there are practical difficulties in measuring performance in general practice. Reliance on medical record audits in general practice has many shortcomings. Referral letters hold many advantages as a tool for audit or quality assessment in general practice: accessibility; acceptability; objectivity; consensus in standard setting for letters; and a positive impact on the quality and cost of management. Professional consensus standards will continue to be developed. If they are to be used for performance measurement, rather than simply serve an educational function, more use can and should be made of referral letters to assess and improve general practitioner performance.