Intended for healthcare professionals


Regions should define audit strategy

BMJ 1996; 313 doi: (Published 24 August 1996) Cite this as: BMJ 1996;313:497
  1. J R M Lough, Assistant adviser in general practice audit
  1. West of Scotland Postgraduate Medical Education Board, Glasgow G12 9LX

    EDITOR,—Both David Sellu and R A Fulton agree that audit is an essential part of medical practice and should be embraced by all.1 2 We would suggest, however, that it is far too early to conclude that “audit is not working” and that resources have been “largely wasted.” The simplest audits often result in the most useful change and can cost nothing. It is attitudes that have to be adjusted, and this takes time. Rigorous systematic audit is more likely to happen with strong leadership, an appropriate infrastructure, and a coordinated programme underpinned by adequate support. “Bottom up” audit, which often results in unfocused audit projects and in which one cycle of audit is rarely completed, is laudable in its goal but limited by time and money. The royal colleges have been slow in coordinating an audit strategy.

    The answer, in general practice at least, is at regional level. Each regional adviser or a named representative should be responsible for defining a strategy for the whole region and encouraging a core programme for all, to ensure an ability to use basic audit methods. The ultimate aim would be to promote a rigorous audit method to be applied to any audit as part of daily practice, with information technology being used to facilitate continuous reaudit.

    This has been our approach in the west of Scotland, where all 155 training practices are implementing a five year audit of workload, five chronic diseases, and the monitoring of critical events. The programme is mandatory and sets explicit standards commensurate with those expected of a training practice in the late 1990s. The audit programme is linked to a regional information technology strategy, with each practice having access to a modem. Results are stored on disk, which allows practices to compare the quality of their care with that of others locally and regionally and (by use of Medline) with evidence based best practice. The idea that changing the name “audit” will wipe the slate clean is facile.


    1. 1.
    2. 2.