General practice accreditation - does time spent on-site matter?

Background. Accreditation to the Royal Australian College of General Practitioners Standards for general practices was developed with the intent of giving assurance to the public as to the safety and quality of general practice. The standards have undergone several iterative changes but have had little empirical validation since the original entry standards. Objective. To compare the rate of indicator non-conformity between a full-day survey visit conducted under the 5th edition standards against the half-day visit conducted under the 4th edition standards. Results. More non-conformities were identified with the 5th edition standards (full-day visit) with a median 86% met (IQR: 14; n = 926) compared with the 4th edition standards (half-day visit) with a median 95% met (IQR: 7; n = 1687; P < 0.0001; bootstrapped t-test). Discussion. The difference in conformity between editions does not appear to relate to different requirements in the two standards editions. The key variable affecting the different outcomes between the edition assessments was time spent on-site by surveyors during a survey visit.