A model for clinical governance in primary care groups

Abstract

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

Medicine misuse or drug abuse? A critical appraisal of current issues and research in the UK

“…4 billion per year and the minimum cost of the social problems generated by severely dependent drug abusers is estimated to be E3-4 billion. 70 With the number of severely dependent drug misusers in the UK estimated to be 100 000-Medicine misuse or drug abuse?…”

“…In contrast, a key objective for the recently formed Primary Care Groups is to optimize the use of the evidence base for medicines to ensure that cost issues do not override the quality agenda, and that health gain for patients remains the focus of the prescribing agenda. 4 During the last decade the use of both prescribed medications and illicit drugs has risen substantially in the UK. Between 1986 and 1996 the total number of prescriptions rose from 345 to 485 million and the average number of prescriptions from 7.3 to 9.9 per head of p~pulation.~ National figures on illicit drugs are harder to ascertain, but household survey data indicate that the proportion of the adult population using drugs had reached 25% (lifetime) and 10% (previous year) by 1994, which probably represents an increase of 50-100% over the decade.…”

Why do patients change their general practitioner? Suggestions on corrective actions

“…One aspect of this approach involves assessing people's ''needs''. This includes not only those strictly relating to their health, but also those regarding their expectations [3]. Particular attention is given to the quality of the relationships between patients and their GPs, as well as to issues of the medical services that the users of these services consider unsatisfactory [4].…”

An overview of clinical governance policies, practices and initiatives

“…2,[18][19][20][21][22][23] Some critics demurred, suggesting this was a fad, a "new label for old ingredients", more top-down managerialism, that clinical governance was more conceptual than useful, or that it would require more of a culture change to implement than had been suggested by its proponents. [24][25][26][27][28] Supportive literature outweighs criticisms by a considerable margin.…”