Table 1.

Indicators proposed in national framework for assessing performance² that are most relevant to primary care

Performance indicators	Available data source	Attributable to health care	Evidence that improved indicator value leads to improved health outcomes
Fair access
To elective surgery: rates of CABG and PTCA, of hip and knee replacement, and of cataract replacement	Yes	Yes	Unclear what ideal rates should be. Only effective if performed on appropriate patients
To family planning services: conception rates for those aged <16	Yes	Limited extent	Yes
To cancer screening services: % of target population screened for breast and cervical cancer	Yes	Yes, but people can refuse	Yes, though evidence for cervical screening based on observational data
To district nurse contacts: district nurse and assisted district nurse contacts for those aged ⩾75, and district nurse contacts lasting >30 minutes for same age group	Yes	Yes	No
Effective delivery of appropriate health care
% of target population vaccinated and % of all orchidopexies for those aged <5	Yes	Yes, but people can refuse vaccination	Vaccination, yes; orchidopexy, limited extent
% of target population screened for breast and cervical cancer (as above)	Yes	Yes, but people can refuse	Yes, though evidence for cervical screening based on observational data
Rates of CABG and PTCA, of hip and knee replacement, and of cataract replacement	Yes	Yes	Only effective if performed on appropriate patients
Age and sex standardised admission rates for severe ENT infection, kidney or urinary tract infection, heart failure (“avoidable admissions”)	Yes	Yes, but patients can self refer to accident and emergency units	Unclear how
Age and sex standardised admission rates for asthma, diabetes, and epilepsy (“largely managed in a primary care setting”)	Yes	Yes, but patients can self refer to accident and emergency units	Unclear how
Volume of prescribing of benzodiazepines, and ratio of antidepressants to benzodiazepines	Yes	Yes	To some extent
Composite measure of prescribing of combination and modified release products plus “drugs of limited clinical value” and inhaled corticosteroids	Yes	Yes	To some extent
Efficiency
% generic prescribing	Yes	Yes	No, but savings made can be invested in effective interventions
Health outcomes of NHS care
Conception rates for those aged <16	Yes	Limited extent	Yes as this is a health outcome indicator
Notification rates for pertussis and measles	Yes	Yes	Yes as this is a health outcome indicator
Emergency hospital admissions for people aged >75	Yes	To some extent, but also reflects social provision	Possibly, but definition of emergency may vary
Rates of emergency psychiatric readmission	Yes	To some extent, but also reflects social provision	Possibly, but definition of emergency may vary

CABG=coronary artery bypass graft; PTCA=percutaneous transluminal coronary angioplasty; ENT=ear, nose, and throat. 

The indicators in the other categories—“Health improvement” (deaths from all causes and cancer registrations) and “Patient/carer experience of the NHS”—are less relevant to primary care.