Step 1: Selection of priority areas for quality indicator development	The clinical areas for which priority quality indicators are most needed were identified by an expert review panel using the nominal group technique; the expert panel was informed by evidence obtained by qualitative interviews with practising primary care clinicians, evidence from a systematic review of effective clinical interventions, and an analysis of unplanned hospital admissions for primary care-sensitive conditions.
Step 2: Identification of relevant recommendations from national guidelines	All national guidelines for England (NICE) and Scotland (SIGN) were reviewed to select those potentially relevant to children and dealing with issues in the prioritised clinical areas. All recommendations were extracted but were selected for further development only if they: 1) made a precise statement about what constitutes high-quality care; 2) defined a standard against which care quality could be measured; 3) were clearly defined; 4) were measurable; and 5) were attributable to actions in primary care.
Step 3: Translation of selected guideline recommendations into quality indicators	To inform the drafting process, exemplar quality indicators were identified from three specific sources: 1) the Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse website; 2) the Royal College of General Practitioners (RCGP) Training Standards and other previously proposed quality indicators for UK general practice; 3) paediatric indicators previously developed by RAND. If the above sources contributed no useful exemplars, PubMed was searched for newly published indicators.
Step 4: Final assessment of quality indicators for feasibility and reliability	All the quality indicators were further assessed by a second expert review panel (with some overlap in membership with the panel that undertook Step 1) using the RAND appropriateness method.