A new framework could be the answer in developing a consistent measure of quality care in general practice.
NSW Health’s Lumos program is marking its tenth anniversary at NSW Parliament House today with the launch of a new initiative: an evidence-based, professionally endorsed tool to measure high-quality care in general practice and to inform funding models that reward it.
The Quality, Equity and Systems Transformation in Primary Health Care (QUEST-PHC) framework, developed in collaboration with primary care clinicians and GPs, was validated via Delphi consensus study in 2025.
The study, published in PLOS ONE, confirmed the framework’s relevance, but its practicality relied on external factors, including existing health system limitations, data-linking challenges, and the willingness, capacity, and time available in general practice.
Lumos is a data linkage program that connects de-identified general practice, hospital, ED, and health service records to map patients’ complete journeys across the healthcare system, and demonstrate the value of primary care.
Its spans regional, remote and metropolitan areas across NSW.
For Lumos’ sample GP 2024 report, 803 NSW practices participated in tracking the patient journeys of more than 6,000,000 de-identified individuals.
These reports could determine patients’ hospitalisation frequency, as well as when potentially avoidable ED visits occurred over an average 24-hour period, and how many patients had a combination of ED presentations, hospital admissions, or died.
Lumos’s previous projects examined the financial benefits of primary care, with an NSW Health cost-benefit analysis using Lumos data finding that for every $1 paid through Medicare rebates at GP practices, the NSW Health system pocketed $1.60 in benefits.
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Professor Penny Abbott, a GP and the chair of General Practice at Western Sydney University, which led the QUEST-PHC, told The Medical Republic data-driven care was “vital” to monitor and consistently improve patient outcomes.
“It is also important for equity, allowing us to understand practice level risk factor and chronic disease activity and ensure we are systematically reaching our patients, including those who may be underserved by health services,” she said.
“The QUEST framework has the advantage of having been developed with general practitioners, and of incorporating what they consider feasible to monitor in general practice right now.”
While keeping patients out of hospital remains crucial, she said more attention was needed for general practices that manage patients diverted from hospital.
“This requires system support, strong care quality care frameworks and monitoring and funding reform so that general practices can deliver the care they know is needed,” Professor Abbott said.
Edweana Wenkart, a PhD student at Western Sydney University under Professor Abbott, said the framework’s implementation was being co-designed as an “integral next step” to ensure its operationalisation meets the needs of the entire health system.
GP Dr Charlotte Hespe, a keynote speaker at today’s Lumos anniversary symposium, told The Medical Republic that while data represented outcomes, qualitative insight was essential to interpreting what results meant.
This included understanding patient demographics and their level of multimorbidity.
“[A GP practice] might sit in a wealthy postcode but attract a whole lot of poor patients who are just over the boundary somewhere, but that’s the practice that’s actually enabling better access and affordability,” Dr Hespe said.
While a high frequency of GP visits does align with preventing patient hospitalisation, Dr Hespe said this doesn’t necessarily translate into providing quality care – “it’s very contextual”.
“In the UK, there are 36 measures of frailty to be able to predict if a patient is frail and needs extra resources. 20 of these we can’t collect in the Australian healthcare setting,” Dr Hespe said.
“We don’t have those data points to be able to do it unless you have a research project that specifically asks for them, and then we have all the issues about the confidentiality of what that data looks like, who is going to share it, and how we use it in the right way,” she said.
“Affordability of health care has to align with funding quality care and funding it in a way that makes sense.”
