Intended for healthcare professionals

General Practice

New Zealand's independent practitioner associations: a working model of clinical governance in primary care?

BMJ 1999; 319 doi: (Published 20 November 1999) Cite this as: BMJ 1999;319:1340
  1. Laurence Malcolm, professor emeritus (,
  2. Nicholas Mays, adviser, healthb
  1. a Aotearoa Health, Lyttelton RD1, New Zealand
  2. b Social Policy Branch, Treasury, Wellington, New Zealand
  1. Correspondence to: L Malcolm
  • Accepted 16 August 1999

Clinical governance has achieved “band wagon” status in recent months in the United Kingdom.13 Yet there remains considerable confusion and uncertainty about its scope and purpose. Since 1991-2, the NHS has invested in the development of clinical audit, but this has rarely been related to the parallel development of various forms of devolved budget holding, both within hospitals and in primary care. However, we believe the integration of clinical and financial accountability is essential for the development of effective clinical governance. Over the past five years, New Zealand's independent practitioner associations have been developing a working model of such clinical governance in primary care. 4 5 We think this is relevant to clinical governance in budget holding primary care groups in England and local health groups in Wales. Although Scotland's local health care cooperatives do not hold budgets or commission services, they too will need to make arrangements for clinicalgovernance.

Summary points

The scope and application of clinical governance in the United Kingdom remain unclear

New Zealand's independent practitioner associations are implementing a working model of clinical governance in primary care

This is achieved through an elected board, accountable to the purchasing authority for large and increasing amounts of public funding

Associations have a well established infrastructure, including staff, information systems, clinical guidelines, peer discussion groups, and personalised feedback on clinical performance

Associations have used budget holding to make savings to develop new and better services

Clinical governance in the NHS

From April 1999, the chief executive of each NHS trust (including new primary care trusts) became responsible not only for the financial health of the organisation but also for the quality of its clinical services. The key elements identified by the NHS to enable this to happen are clinical audit, clinical risk management, quality assurance, clinical effectiveness, and staff and organisational development.6 …

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