Improving Quality And Safety Progress In Implementing Clinical Governance In Primary Care

Primary Care Trusts (PCTs) are responsible at the local NHS level for the statutory "duty of care", largely through implementing clinical governance. The concept of clinical governance aims to improve continuously the overall standard of clinical care; reduce variations in outcomes of, and access to, services; and ensure that local decisions are based on the most up to date evidence of what is known to be effective. The key principles of clinical governance are: a coherent approach to quality improvement, clear lines of accountability for clinical quality systems and effective processes for identifying and managing risk and addressing poor performance. Clinical governance, implemented effectively, can provide PCT Chief Executives with assurance that healthcare, whether provided directly or commissioned from other providers, is both safe and of good quality. This report finds that the organisational structures and processes for clinical governance have largely been put in place at PCT level. But progress in implementing the different components of clinical governance varies both within and between PCTs. More needs to be done to provide assurance about the performance of General Practitioners and the systems which protect the safety of patients. Key features of those PCTs that can demonstrate consistent improvements in quality include effective clinical leadership, maintaining the capacity to deliver services, ensuring the quality of the patient experience and improving services based on lessons from complaints and patient safety incidents. The higher performing PCTs are characterised by: availability and accessibility of information to support evidence-based medicine; all staff appraised against an agreed work and development programme; service users involved in service development; clear action plans developed in response to clinical risks; and underperformance by clinical staff addressed by clear management procedures.

Following serious concerns about clinical and organisational failures in the NHS during the 1990s (such as Alder Hey, the Bristol Royal Infirmary and Shipman), the Government identified the need for a more systematic approach to improving quality and safety in healthcare. The Department of Health introduced clinical governance, a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. Primary Care Trusts (PCTs) are responsible for providing primary care services and commissioning services on behalf of their local health economy. This report examines the Department's progress in implementing clinical governance in primary care; the lessons learned; and the risks that will need to be managed if quality and safety are to be embedded in the new PCTs. that clinical governance is not as well established in primary care as in secondary care, largely because of the complexity of PCTs role in both commissioning and providing care; and the independence of contractors delivering healthcare, particularly General Practitioners (GPs). Primary care has also been slower in adopting a structured approach to quality and safety, evident for example in the lack of compliance with national systems reporting of clinical incidents. There is a lack of clarity between PCTs and their contractors as regards accountability for ensuring quality and safety, and scope for greater involvement of patients and the public in ensuring that primary care services are safe and of high quality.

Clinical Governance is integral to healthcare and all doctors must have an understanding of both basic principles, and how to apply them in daily practice. Within the Clinical Governance framework, patient safety is the top priority for all healthcare organisations, with the prevention of avoidable harm a key goal. Traditionally medical training has concentrated on the acquisition of knowledge and skills related to diagnostic intervention and therapeutic procedures. The need to focus on non-technical aspects of clinical practice, including communication and team working, is now evident; ensuring tomorrow's staff are competent to function effectively in any healthcare facility. This book provides a guide to how healthcare systems work; their structure, regulation and inspection, and key areas including risk management, resource effectiveness and wider aspects of knowledge management. Changing curricula at undergraduate level reflect this, but post-graduate training is lagging behind and does not always equip trainees appropriately for a hectic clinical environment. An Introduction to Clinical Governance and Patient Safety presents a simple overview of clinical governance in context, highlighting important principles required to function effectively in a pressurised healthcare environment. It is presented in short sections based on the original seven pillars of clinical governance. These have been expanded to include the fundamental principles of systems, team working, leadership, accountability, and ownership in healthcare, with examples from everyday practice. This format is designed to facilitate use as a 'pocket guide' which can be dipped into during the working day, as well as for general reading. Examples from all branches of medicine are presented to facilitate understanding. Contributors are taken from a broad base - from junior doctors to internationally recognised experts - ensuring issues are addressed from all perspectives.

Clinical Governance: A Guide to Implementation for Healthcare Professionals provides a comprehensive overview of what is meant by clinical governance and how it can be implemented in practice. It explores the evolution of clinical governance, its key components, legal implications, the barriers to implementing it, and its impact. Clinical Governance provides step-by-step practical advice, facilitating better understanding of the key principles of clinical governance. This third edition has been fully updated throughout to incorporate a more integrated approach to achieving clinical governance, with an additional chapter on education and training. Each chapter includes reflective questions, activities and case studies taken from clinical practice as well as a full list of references and further reading.

This new text is an accessible and practical guide to clinical governance in healthcare, designed to help practitioners and students deliver quality care to patients and improve the patient experience at every level. Grounded in the application of clinical governance, it explains in detail what it looks like in practice. Using common examples of clinical governance challenges, this book gives real and practical insights into how individuals can contribute to clinical governance in a range of healthcare settings. Each chapter includes case studies, reflective activities, tips and real experiences to help readers apply the theory to practice, and identify areas in which they can improve the patient experience. This is key reading for all healthcare practitioners. "In this excellent new book on clinical Governance, Mary Gottwald and Gail Lansdown distil down what this complex topic encompasses. They put bones on the individual components and lead the reader easily through the topic, so that he or she ends up with a good understanding of how the system is supposed to function and their individual responsibilities as a clinician, academic, trainer or manager ... I wish that I had been able to read a book such as this when I started off. It would have saved me a lot of time and trouble getting my head around all the aspects of this vital topic. Providing a reliable, safe, high quality service is the major challenge for all of us working in health services, so this fine book is very welcome." Dr Peter Featherstone MPhil, FRCP, Lead for Clinical Governance in Acute MedicineConsultant Physician and Honorary Medical Senior Lecturer Portsmouth Hospitals NHS Trust "The book has been developed for pre- and post - registration students, but it will appeal to a wider audience, particularly those who want more knowledge of Governance and its antecedents. The outline of Chapters at the start helpfully leads the reader the appropriate section, and within each section the authors attempt to link clinical governance theory to practical examples. This is further emphasised by the use of reflective questions at the end of each chapter. The chapter on Clinical Audit is excellent, and is of use to anyone including medical staff in terms of how Clinical Audits should be conducted. It is an excellent, easy read journey through all aspects of Clinical Governance and its application to patient experience, safety and effective senses, ultimately quality of care." Sharon Linter, Director of Quality and Governance/ Executive Nurse, Cornwall Partnership NHS Foundation Trust

This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.

Patient-Centered Care Series Series Editors: Moira Stewart Judith Belle Brown and Thomas R Freeman Primary care clinicians are often unfamiliar with new and effective methods for detecting substance abuse problems in their earliest stages and the majority of patients with substance abuse problems remain undiagnosed. Substance Abuse is written by primary care clinicians and focused to meet the needs of primary care providers demonstrating how the patient-centered clinical method can assist clinicians in learning how to diagnose this complex psychosocial disorder. This book describes how to use state-of-the-art screening techniques and how to understand and motivate patients to decrease or eliminate harmful use of alcohol and drugs. It presents the latest scientific findings and gives examples of using a patient-centered approach as well as describing specific communication skills with samples of dialogue illustrating their use in helping substance-abusing patients. This is essential reading for all family doctors paediatricians gynaecologists psychiatrists nurses social workers psychologists and all clinicians whose practices include substance abusing patients. It will also appeal to counsellors education personnel and all professionals working with substance abusing individuals. For more information on other titles in this series please click here