Promoting medical audit in primary care: A qualitative evaluation of medical audit advisory groups

The 1989 policy on medical audit in primary care required each family health services authority (FHSA) to establish a medical audit advisory group (MAAG) to direct, coordinate and monitor medical audit activities among all general practices in its district. The aim of the thesis is to assess the capacity of the MAAG structure to fill this role effectively. The thesis includes analysis of the historical and political circumstances surrounding the introduction of the policy on medical audit, discussion of the principles and practice of audit in general practice and a brief review of what is known about the effectiveness of audit in bringing about improvements in patient care. The empirical core of the thesis is a qualitative study of the activities and progress of 15 MAAGs in two English health regions undertaken in 1992. The purpose of the study was to inform future development of policy and practice in relation to MAAGs at both national and local levels by a) "mapping" the implementation of the MAAG programme in order to develop knowledge and understanding of how different MAAGs had evolved, what they were doing and why they were working in particular ways; and b) using the knowledge and insights gained from this exercise to assess and explain progress (or lack of it) towards achieving the objectives of the audit programme. The methodology of the study involved semi-structured interviews with MAAG chairs and support staff and FHSA managers and independent medical advisers in each of the 15 study districts and analysis of relevant documentary material. The findings of the study show that the study MAAGs were broadly working in accordance with their brief. They were also playing a valuable role in supporting primary care development. Nevertheless, in most respects the detailed expectations of the audit programme were not being met, nor were the anticipated benefits apparently being achieved. The study findings provide the basis for a discussion of the viability and appropriateness of the MAAG structure as a means of promoting audit in primary care which also takes account of the developments that have taken place in relation to MAAGs in the three years since the data were collected