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Doctors working in any branch of medicine aim to provide and to improve quality on a continuous basis. Teaching and research are intended to underpin these processes. Quality measurement attempts to check that these aims are being met. In the UK, for general practice, within-profession initiatives served the public adequately until well into the 1980s, as testified by the founding of the College of General Practitioners in 1952, the establishment of Departments of General Practice throughout the 1960s and 1970s, and the ‘GP Charter’ of 1966—all of which were responses to the groundbreaking exposure of the state of UK general practice of the early NHS years in the Collings Report of 1950.1 The discipline’s ill-considered rejection of the government’s ‘good practice allowance’ initiative in 1985 marked its failure to recognize the growing wish of public and government for more explicit quality accountability and the guaranteeing of minimum standards of care and competence. The ‘imposed’ 1990 Contract and the series of initiatives around clinical governance which have followed have been a direct consequence. The creation of NICE (the National Institute for Clinical Excellence), of clinical guidelines, of the National Service Frameworks (initially for cardiovascular disease, cancer and mental health), and moves to establish a workable basis for re-accreditation have all highlighted the real difficulty in finding ways of conceptualizing and measuring quality of care in ways which capture the full range of issues that matter to patients and can be applied in day to day practice. Campbell and Roland2 have proposed a categorization for conceptualizing and measuring quality which describes access and effectiveness as its two principal components, and subdivides effectiveness into clinical effectiveness and interpersonal effectiveness (efficiency and equity are added as separate issues). That categorization has similarities to, but important differences from, the division of effectiveness into technical and interpersonal effectiveness originally proposed by Donabedian.3 This essay argues, amongst other things, that the importance of inter-personal effectiveness—the more difficult component to define and measure—is, because of the difficulty in operationalizing it, in danger of being lost under the weight of material on the biomedical component of clinical effectiveness. This essay first describes the evolution of thinking within the discipline of general practice about its ‘core values’. It then discusses the definition and measurement of two of these ‘core values’ (‘patientcentredness’ and ‘holism’) in more detail. Next, it traces the development of the Consultation Quality Index (CQI), an opportunistically developed instrument designed to capture and measure a range of quality issues (most successfully at doctor level) at the interface between clinical/technical and interpersonal effectiveness, and suggests a number of ways in which it might be applied. Finally, the essay discusses how current and future work might strengthen the CQI and help ensure that the importance of inter-personal care will not be lost from the ‘quality agenda’ in general practice.

Quality, core values and the general practice consultation: issues of definition, measurement and delivery