Intended for healthcare professionals


Primary care pays only “lip service” to clinical governance, MPs say

BMJ 2007; 335 doi: (Published 13 September 2007) Cite this as: BMJ 2007;335:529
  1. Michael Day
  1. London

    Defective communication between primary care trusts and GPs is seriously compromising the safety of patients in England, a group of MPs said this week.

    In its latest report the House of Commons Committee of Public Accounts also warns that 96% of GPs are failing to report dangerous incidents to the National Patient Safety Agency.

    For its report, which examines the Department of Health's progress in implementing clinical governance in primary care, the committee had taken evidence from the chief executive of the NHS, the deputy chief medical officer, and the NHS's director general of commissioning.

    Committee chairman Edward Leigh said, “Too many primary care organisations are paying lip service to the principles of the Department of Health's clinical governance agenda. The lines of communication between the primary care trusts, on the one hand, and their GPs and other healthcare contractors, on the other, are defective.”

    He added: “How can we be confident in the NHS's ability to share learning locally and nationally about what can go wrong in health care when only a tiny proportion of GPs—4%—routinely report patient safety events and incidents to the National Patient Safety Agency?

    “Given that the central aim of the agenda is accountability for improving service quality and patient safety, that's a poor state of affairs.”

    In response to a series of high profile problems in the 1990s, including the Shipman murders and events at Alder Hey Hospital and the Bristol Royal Infirmary, the health department introduced its 10 year programme to boost patient safety. The centrepiece was the clinical governance system, through which NHS organisations were to be accountable for continuously improving the quality of their services and safeguarding high standards of care.

    The new report suggests, however, that clinical governance is not as well established in primary care as in secondary care. The committee says that this is due largely to the complexity of the role of primary care trusts in commissioning and providing care and to the independence of contractors delivering health care, particularly GPs.

    The report adds that primary care has also been slower in adopting a structured approach to quality and safety, noting the lack of compliance with national systems reporting of clinical incidents.

    Mr Leigh said, “Primary care trusts must get the message across that clinical governance systems and processes must be applied on a day to day basis to drive up standards of quality and safety.

    “They are not just a set of principles on paper—something to be piously nodded through at management meetings and forgotten.”

    In June this year the London out of hours GP service Camidoc was criticised for having no clinical governance plans in place, after eight of its doctors failed to diagnose septicaemia in a 41 year old woman who later died (BMJ 2007;334:1130 doi: 10.1136/bmj.39227.482731.4E).

    Commenting on the report, David Stout, director of the NHS Confederation's PCT Network, which represents most primary care trusts, said: “Primary care providers have the ultimate responsibility for the quality and safety of their services, and PCTs have a statutory duty to make sure that the services they commission are clinically safe and effective. PCTs take these responsibilities extremely seriously.

    “We acknowledge that systems of clinical governance in primary care have historically been less well developed when compared with secondary care services. However, PCTs now have much stronger mechanisms, including the GP contract, to address any shortcomings.”


    • Improving Quality and Safety—Progress in Implementing Clinical Governance in Primary Care: Lessons for the New Primary Care Trusts can be found at

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