To break their destructive antagonism over issues of health service modernisation, doctors and managers should engage more directly with nursing and allied health professionals when responding to reform initiatives

The current focus on quality and safety means most doctors have negative views about clinical governance. But done properly, clinical governance has the power to improve NHS performance

We investigated the reasons why the transition from paper to electronically formatted records during patient handover between ambulance crews and emergency department staff in a North East England Emergency Department has not always been viewed positively. Interviews with seven paramedics and three emergency department staff were conducted in addition to observations of 74 ambulance staff during 37 handovers in the emergency department. In just over half of the handovers (20), paramedics found it necessary to provide written information to aid emergency department staff, in addition to that recorded electronically. There were a number of issues that impeded the ready utilisation of electronic records in this context. The major factors identified as contributing to this were the choice of system architecture, the design of user interfaces, and the procurement process used by the National Health Service. We have made some suggestions about how the system could evolve from one focused on providing management information to one that also supports operational needs.

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We were interested to read the article by Dinniss et al (Psychiatric Bulletin, March 2007, 31, 107-109) on qualifications in clinical education for psychiatrists. We wish to draw attention to postgraduate programmes in medical education (including MSc, PGDip and PGCert) run by Durham University, which did not feature in the list. These are particularly relevant in that Dinniss et al identify a number of deficiencies in the course they undertook: some modules only had marginal relevance to their needs, and they would have valued greater opportunities to develop practical skills in delivering teaching and supporting learning. Our programmes have a strong bias towards practical approaches as opposed to being focused on research, although of course good teaching practice is also research informed. Details of our courses are available from the Durham University website at