Are essential for effective clinical governance

Clinicians are under siege from patients and politicians alleging limitations in professional self regulation. In Britain the General Medical Council's attempts to retrieve the situation are criticised by some as belated, or even unjust,1 and the emergence of clinical governance in the NHS is regarded by some as an arbitrary system for imposing uniform standards and monitoring compliance. Are such misgivings reasonable? Clinical governance should promote high quality care by making individuals accountable for setting, maintaining, and monitoring standards, to produce a hitherto elusive culture of clinical excellence.2 Systems of clinical risk management and audit should contribute to this process by facilitating greater self evaluation, open debate about clinical practice, and the routine investigation of adverse events. For clinicians to learn and improve, conclusions reached during these processes need to be documented Clinicians also need to feel safe with the process and that it will not be used against them.

In practice these worthy objectives are undermined by two legal concerns relating …