Clinical audit has lacked a national strategy and cooperation from GPsBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2422 (Published 05 November 2008) Cite this as: BMJ 2008;337:a2422
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I was disappointed to read your news item which delegates stated it
was hard to get co-operation from GPs to participate in audit. Having
been involved in promulgating the cause of clinical audit as a universal
professional activity ever since the implementation Kenneth Clarke's
"Working for patients" Working paper 6, both as MAAG director for
Birmingham Health Authority and, from 1994 to 1997, chairman of the
Department of Health's National Primary Audit Group, I have seen how GPs
have incorporated audit into routine practice. Since 1994, every GPR has
submitted an audit or equivalent project as a written submission for
The whole Quality Outcomes Framework is a national primary care audit
exercise, albeit with Departmental set targets and financial incentives.
As a GP appraiser and QOF assessor, I see virtually all GPs are
undertaking and noting their Significant Event Audits.
Certainly the nGMS contract has failings: annual appraisal (though a
valuable developmental exercise) is the only obligatory and funded
educational activity required of GPs now. Otherwise the contract states
precisely the expected duties of GPs and undoubtedly more and more time is
being spent on administrative activities, form filling and data collection
for governmental targets, so it is hardly surprising that GPs are becoming
less willing to undertake extra-contractual activities, which may
interfere with time dedicated to the consultation
Communal(as opposed to single practice)local audit in general practice
ceased with the abolition of the District Health Authorities, as PCTs had
no specific funding to continue audit support and the concept of clinical
governance was embraced at the expense of straightforward audit activity.
It is a pity that the delicate nurturing of co-operative audit throughout
the nineties was allowed to wither, even though individual practices and
general practitioners have continued to use and teach and learn through
their acquisition of audit skills.
Competing interests: No competing interests