Clinical governance is the core component of the new quality programme for the NHS (see box on next page) announced in the consultation document A First Class Service.1 It is described as "a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish." It will be the central focus for assuring the quality of care and addressing the issue of providing accountability through the Commission for Health Improvement. The activities of the commission will reflect national and local priorities as identified by the National Institute of Clinical Excellence and health improvement programmes respectively. Although A First Class Service included details about the structure and functioning of clinical governance in health service trusts, arrangements for primary care groups were not specified. In this paper, we suggest a possible model for clinical governance in primary care groups.
Model preceptsThe model is based on three underlying precepts:x Clinical governance encompasses both quality improvement and accountability-systems for both must be developed fully if the highest levels of quality of care and professional performance are to be shown to have been achieved; x Quality improvement and accountability depend on effective methods of changing performance-without these, clinicians and primary care groups cannot improve quality or account for it. Fortunately, there is growing evidence about the effectiveness of methods of changing performance that can be used to guide arrangements for clinical governance [3][4][5] ;
Summary pointsClinical governance is central to the NHS quality programme, but how it will operate in primary care groups remains unclear Although many activities included in the new concept of clinical governance are already being undertaken, these need to be coordinated A model of governance that addresses the core tasks of defining, accounting for, and improving quality and incorporates evidence on effective methods of changing performance is suggested This model can improve professional, practice, and primary care group performance It shows how groups can introduce and develop clinical governance and how health authorities and the Commission for Health Improvement can monitor progress
This study shows the feasibility of collating audit data and the potential of this approach for describing patterns of care and highlighting general and local deficiencies. Information about levels of performance in large numbers of patients can be used to set standards or norms against which individual practitioners can compare their own activity. Comparison of the health needs of local populations with national data could be used to inform commissioning services. However, audits should employ uniform evidence-based criteria so as to facilitate collation and allow comparison.
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