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Quality improvement in general practice: enabling general practitioners to judge ethical dilemmas
  1. Laura Tapp1,
  2. Adrian Edwards2,
  3. Glyn Elwyn3,
  4. Soren Holm4,
  5. Tina Eriksson5
  1. 1Department of Psychology, University of Southampton, Highfield Campus, Southampton, UK
  2. 2Department of Primary Care and Public Health, Cardiff University, Neuadd Meironydd Heath Park, Cardiff, UK
  3. 3Clinical Epidemiology Interdisciplinary Research Group, Department of Primary Care and Public Health, Cardiff University, Neuadd Meironydd Heath Park, Cardiff, UK
  4. 4CSEP, School of Law, University of Manchester, Manchester, UK
  5. 5Department of Family Medicine, Institute of Public Health, Copenhagen, Denmark
  1. Correspondence to Laura Tapp, Department of Psychology, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK; l.tapp{at}


Quality improvement (QI) is fundamental to maintaining high standards of health care. Significant debate exists concerning the necessity for an ethical approval system for those QI projects that push the boundaries, appearing more similar to research than QI. The authors discuss this issue identifying the core ethical issues in family medicine (FM), drawing upon the fundamental principles of medical ethics, including principles of autonomy, utility, justice and non-maleficence. Recent debate concerning the application of QI ethics boards is discussed with relevance to primary care and issues such as general practitioner (GP) intentions, the impact of QI on patients and the use of confidential patient data and the impact of dissemination. The authors conclude that a system of QI ethical approval leaves many issues unresolved and potentially creates several barriers to implementing QI. To ensure ethical QI work is generated within FM it is essential for GPs to learn about and engage in more ethical reflection so that they can better judge and resolve these issues.

  • Ethics
  • family medicine
  • quality improvement

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  • Competing interests None. The handling editor was Richard Ashcroft.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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