Intended for healthcare professionals

General Practice Clinical governance in primary care

Improving quality in the changing world of primary care

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7260.551 (Published 02 September 2000) Cite this as: BMJ 2000;321:551
  1. Rebecca Rosen (rrosen@kehf.org.uk), fellow in primary care
  1. King's Fund, London W1M 0AN

    This is the first in a series of five articles Series editor: Rebecca Rosen

    Publication of A First Class Service placed quality improvement at the centre of the health policy stage.1 The term clinical governance was used to capture the range of activities required to improve the quality of health services. Central among these were the need for all NHS organisations to develop processes for continuously monitoring and improving the quality of health care and to develop systems of accountability for the quality of care that they provided.

    Evidence based practice, audit, risk management, mechanisms to monitor the outcomes of care, lifelong learning among clinicians, and systems for managing poor performance will all contribute to the development of effective clinical governance. In addition, the term combines an emphasis on improving care for individual patients with quality improvement targeted at whole populations. This wide ranging approach creates a challenge for those leading the implementation of clinical governance.

    International examples of quality improvement work in primary care

    Peer review and individual feedback on clinical performance (New Zealand)—Voluntary membership of independent practitioners' associations in which aspects of clinical practice by participating general practitioners are reviewed through peer discussion groups with a view to reducing expenditure3

    Lifelong learning (Germany)—Diploma run by state medical association for fully trained doctors with five years' experience. Based on 200 hours of teaching covering guidelines and best practice, health economics, and quality management4

    Revalidation of doctors (Norway)—Recertification every five years, based on 200 hours of continuing medical education and three months' work in a hospital. Linked to a 10-15% pay increase5

    Public involvement in medical regulation and accountability (Canada)—Lay representation on governing councils of medical colleges, registration committees, and complaints and disciplinary committees6

    Technology assessment programmes to promote effective practice (UK, Spain, Netherlands, and other countries)—Well established technology …

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